Posterior pillar augmentation palatoplasty (PPAP+Re:IVVP): outcome of a modified procedure for VPI

Posterior pillar augmentation palatoplasty added to the secondary intravelar velolplasty (PPAP + Re:IVVP) is a modification of re-repair technique intended to lengthen the palate. The current study aims to report the technical details of the modified procedure, its outcome and suggest its indication within the velopharyngeal incompetence (VPI) management protocol. A prospective cohort study examined a consecutive patient series who underwent PPAP + Re:IVVP for VPI during the period from 2015 to 2021. Speech outcome using the Cleft Audit Protocol for Speech (CAPS) score, complications and predictive factors for outcome were reported. Fifty-five cases had PPAP + Re:IVVP procedure with a mean age at the procedure of 87.6 months (range 27-256). The primary diagnoses were unilateral cleft lip and palate in 25 cases (44.5 %), bilateral cleft lip and palate in 12 cases (21.8 %), isolated cleft palate in 15 cases (27.2 %) and submucous cleft palate in 3 cases (5.5 %). There were statistically significant improvements in all speech score parameters. Hypernasality mean score changed from 3.36 ± 0.60 to 1.82 ± 1.22 (p < 0.001), nasal emission from 1.9 ± 0.88 to 0.88 ± 0.32 (p = 0.015) and the intelligibility from 2.68 ± 0.65 to 1.48 ± 1.16 (p = 0.045). The mean follow up period after the procedure was 23.9 ± 14 months. The age of surgery (p = 0.034), diagnosis (p = 0.004), fistula (p = 0.038) and preoperative nasality score (p = 0.033) were the significant predictive factors affecting outcome. PPAP + Re:IVVP is a modified procedure for VPI showing significant improvement in all speech scores and might be best suitable for short pliable palates. Further study is needed for a clearer description of patient selection to optimize outcomes.