Intravelar veloplasty: a prospective study

Preliminary results are reported from a prospective, alternated, single-institution study of the effect of intravelar veloplasty (IVV) upon postpalatoplasty velopharyngeal incompetence. Two senior surgeons standardized their operative procedures and then performed or directly supervised all surgery. Patients alternately had palatoplasty with or without IVV. One speech pathologist conducted all perceptual speech and language evaluations without knowledge of the surgical procedure when the children were 3 years of age. The IVV and non-IVV groups were similar with respect to cleft anatomy, mean age at palatoplasty, and audiograms at 1 and 3 years of age. The findings from a sample of 51 patients were that surgical retropositioning and approximation of the levator muscles during initial palatoplasty (1) did not demonstrably affect the incidence of postpalatoplasty auditory perceptual symptoms of velopharyngeal incompetence; (2) required a significantly longer operating time; (3) were costlier than the control procedure; and (4) did not have greater morbidity than the control procedure. These findings suggest either that there is no beneficial effect of IVV upon postpalatoplasty velopharyngeal competence or that the effect, if present, is of small magnitude.