A comparison of three techniques of palatorrhaphy: early speech results

Sixty-two patients with cleft lip and palate or cleft palate were randomly assigned an operative technique for primary palatorrhaphy: V-Y pushback, Langenbeck, or Langenbeck with pharyngeal flap. Early speech results were evaluated in 52 patients. There were no differences among the treatment groups in late complications, hearing, middle ear disease, velopharyngeal competence, or need for speech therapy, speech bulbs, or secondary pharyngeal flaps. As previously reported, the in-hospital morbidity in these patients was greater with V-Y pushback (more blood transfusions) and Langenbeck plus pharyngeal flap (more upper airway obstruction) palatorrhaphies than with the Langenbeck procedure. The addition of a pharyngeal flap to primary palatorrhaphy seems unnecessary in at least 75% of patients. Therefore, we currently recommend the Langenbeck palatorrhaphy for primary cleft palate repair, although further longitudinal studies of these patients are needed to assess later speech results and maxillary growth.