Palatal Osteogenesis After Cleft Palatoplasty: Does the Bone Grow?

ObjectiveHard palate osteogenesis after primary palatoplasty is a concept that remains poorly defined. This study aims to investigate the impact of palatoplasty on hard palate osteogenesis.DesignRetrospective cohort study.SettingTertiary care academic hospital.PatientsSixty-six patients who underwent primary palatoplasty followed by postoperative computed tomography (CT) imaging.InterventionsPrimary palatoplasty and postoperative CT imaging obtained at least 1 year after surgery.Main outcome measuresThe primary endpoint is the dimensions of the hard palatal cleft after palatoplasty. Secondary endpoints included fistula formation and the impact of surgical technique and age at palatoplasty on residual cleft size.ResultsNo patients achieved complete osseous closure of the hard palate, with an average residual cleft involving 41.4% ± 16.8% of the hard palate. Veau IV patients exhibited the largest residual clefts and highest rates of fistula formation. Larger cleft defects were significantly associated with an increased fistula risk, with a 0.64% increase in fistula formation for every 1% increase in hard palate involvement. Palatoplasty performed before age 1 was associated with significantly smaller residual clefts than surgery after age 2 (P = .03). Patients undergoing Von Langenbeck palatoplasty had smaller residual clefts compared to the 2-flap Bardach technique.ConclusionsIn this study of 66 patients, no patients demonstrated complete osseous regeneration after palatoplasty. Patients undergoing palatoplasty before age 1 and patients undergoing Von Langenbeck palatoplasty had the smallest residual clefts, which may suggest increased osteogenesis at the hard palate in these groups.