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The Effect of Palatoplasty on Growth
Abdiasis Abdilahi1, Seth Ramin2, Cassandra Meyer3
1University of Minnesota Medical School-Twin Cities, Minneapolis, Minnesota, U.S.A.
Insights
Palatoplasty surgery did not significantly improve growth velocity in children with cleft palate who could eat orally. Undernourished children showed no clinically meaningful increase in postoperative growth percentiles after the procedure.
Area of Science:
- Pediatric surgery
- Craniofacial anomalies
- Growth and development
Background:
- Cleft palate repair (palatoplasty) is a common surgical intervention in children.
- The impact of palatoplasty on growth velocity, particularly in relation to nutritional status, requires further investigation.
- Understanding growth patterns post-surgery is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the effect of palatoplasty on the growth velocity of orally fed children with cleft palate.
- To compare growth outcomes between undernourished and nourished children undergoing palatoplasty.
- To determine if palatoplasty independently influences postoperative growth.
Main Methods:
- Retrospective chart review of 192 children who underwent cleft palate repair between 2006 and 2022.
- Data included demographics, weight gain, and WHO growth percentiles.
- Nutritional status categorized as undernourished (≤3rd percentile) or nourished (>3rd percentile).
Main Results:
- Both undernourished and nourished groups showed a significant decrease in weekly weight gain post-surgery.
- Nourished children experienced a greater increase in median growth percentile (3.3%) compared to undernourished children (0.23%).
- The reduction in weight gain was similar across nutritional statuses, but the absolute growth percentile increase was significantly higher in nourished children.
Conclusions:
- Palatoplasty does not independently enhance growth velocity in children with cleft palate who can maintain an oral diet.
- Undernourished children did not exhibit clinically significant improvements in postoperative growth percentiles.
- Surgical intervention alone may not be sufficient to overcome growth deficits in undernourished populations.
Objectives:
To assess the effect of palatoplasty on growth velocity in undernourished and nourished orally fed children with cleft palate.
Methods:
A retrospective chart review was conducted using a data query with cleft-associated ICD-10 and ICD-9 codes to identify children who underwent cleft palate repair between 2006 and 2022 at a tertiary pediatric hospital. Data gathered included demographics, admission variables, weight gain, and weight percentile as per the WHO growth chart data. Inclusion was limited to patients with complete growth data and without parenteral feeding support. Nutritional status was defined as undernourished (≤3rd percentile) and nourished (>3rd percentile). Between and within-group comparisons were made using nonparametric tests.
Results:
A total of 192 patients met the study criteria. Among undernourished patients, the median pre- and postsurgical weekly weight gain was 0.09 kg and 0.05 kg (p = <0.0001), and the median growth percentiles were 0.67% and 1.1%, respectively (p = 0.03). Among nourished patients, the median pre- and postsurgical weekly weight gain was 0.12 kg and 0.07 kg (p = <0.0001), and the median growth percentiles were 25.4% and 29.5%, respectively (p = <0.0001). The postsurgical reduction in weight gain per week was similar across nutritional status (p = 0.43), however, the nourished group demonstrated a larger increase in median growth percentile (3.3% vs. 0.23%; p = 0.03).
Conclusion:
This study demonstrates that palatoplasty does not independently improve growth velocity in children who were able to maintain an oral preoperative diet. In the case of undernourished children, there was no clinically significant improvement in postoperative growth percentiles.
Level Of Evidence:
3 Laryngoscope, 134:5145-5151, 2024.
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