Demography and Surgical Interventions of Submucous Cleft Palate: A Single-center Retrospective Case Series

Submucous cleft palate (SMCP) is a subtle and occult subtype of cleft palate. Diagnosis is often delayed due to inconspicuous clinical features of the SMCP. This study aims to investigate the demography of SMCP patients, to determine when SMCP patients are operated on, and to analyze the surgical technique applied to correct SMCP in our center.

Medical records in Hospital Pakar Universiti Sains Malaysia (HPUSM) from 1999 to 2023 were retrospectively reviewed. Patients diagnosed with SMCP who were operated on were identified. The variables extracted from the records include gender, ethnicity, age at diagnosis, age at surgery, antenatal history, genetic study, associated signs and symptoms, other conditions and anomalies, associated syndromes, surgical techniques, and complications.

A total of 21 SMCP patients who underwent repair were identified. However, only 15 complete medical records were obtained. The mean age of surgery is 68.4 months, ranging from 5 to 212 months. The majority of patients at 47.6% underwent Bardach's two-flap palatoplasty. Other techniques identified were Veau-Wardill-Kilner palatoplasty, Von Langenbeck palatoplasty, Furlow double-opposing Z-palatoplasty, and intravelar veloplasty.

This retrospective case series reported that SMCP patients were operated at a later age. The higher average age of surgery is multifactorial and likely includes delayed diagnosis. Various surgical techniques may be used to repair the SMCP. A high level of suspicion of SMCP is paramount when the clinical features of cleft palate are subtle, but patients exhibit other suspicious signs such as recurrent episodes of otitis media, nasal regurgitation, or speech impediments.