Cleft palate re-repair—a clinical and radiographic study of 32 consecutive cases

doi:10.1016/0007-1226(94)90068-X

British Journal of Plastic Surgery

Volume 47, Issue 6, 1994, Pages 406-410

https://doi.org/10.1016/0007-1226(94)90068-X Get rights and content

Abstract

The results of clinical and radiographic assessment of palate re-repair (by a single operator) in 32 patients are presented.

This has shown that radical muscle correction as a secondary procedure (following limited or no muscle correction in primary repair) has produced measurable improvement in velar function and should be considered as the first option in many patients with velopharyngeal incompetence.

The results also support the concept of muscle dissection and retropositioning in primary cleft palate repair.

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Treatment algorithm for velopharyngeal dysfunction in patients with cleft palate: a systematic review
2023, British Journal of Oral and Maxillofacial Surgery
The aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm. A systematic review was done, by searching Pubmed, Scopus, and Web of Science electronic databases, following the PRISMA guidelines. Articles reporting speech assessment results of secondary VPI surgeries on non-syndromic patients with CP. Surgical techniques were categorised into two groups; palatal and pharyngeal surgeries. Raw data were extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting the patients’ selection for each technique. Our results showed comparable success and complication rates among these techniques. However, the factors governing selection of each technique were identified and taken into consideration to reach a preliminary algorithm. A preliminary treatment algorithm is described based on the results of our review; the most important factors affecting the technique choice are: VP gap size, LVP position, palatal mobility, palatal scarring, VP closure pattern, and age of the patient.
A multidisciplinary approach to sphincter pharyngoplasty for correction of velopharyngeal dysfunction following repair of cleft palate
2022, Chinese Journal of Plastic and Reconstructive Surgery
Management of severe velopharyngeal dysfunction is best performed by a multispecialty team. This team could include a speech-language pathologist, otolaryngologist, prosthodontist, and a plastic surgeon. The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps. In this study, a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.
Twenty patients underwent sphincter pharyngoplasty. Preoperative diagnosis was performed using auditory perceptual assessment, nasoendoscopy assessment, nasometry, and videofluoroscopy.
There were statistically significant differences between the preoperative and postoperative assessments. Bleeding occurred in two patients. Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months, and one patient experienced slight wound dehiscence.
Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.
Induced ankylosis of primary canines for absolute anchorage in the treatment of a patient with Class III malocclusion and cleft soft palate
2019, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
The superimposition of the posttreatment and 4-year retention radiograph tracings showed slight growth of both maxilla and mandible (SNA from 76.2° to 76.6°, SNB from 73.8° to 75.9°, ANB from 2.4° to 0.7°) associated with slightly proclined upper and lower incisors (L1-MP from 91.3° to 93.1°, U1-SN from 105.9° to 109.9°; Fig 14). Cleft soft palate is a congenital deformity of the orofacial cleft with the continuity of the lips and hard palate maintained, leading to speech distortion, skeletal discrepancy, and dental abnormalities.8-10,26 The treatment for such patients is complicated, and multidisciplinary work is essential with the help of otolaryngologists, oromaxillofacial surgeons, dentists and orthodontists, speech pathologists, etc.27 And the success depends on the extent of the cleft, the timing and technique of surgical procedures, skeletal growth pattern, individual growth potential, timing of orthodontic or orthopedic intervention, and the patient's cooperation.28-30
Response to: Time course of improvement after re-repair procedure for VPI management
2018, Journal of Plastic, Reconstructive and Aesthetic Surgery
Time course of improvement after re-repair procedure for VPI management
2018, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
‘Palate re-repair’ is a procedure which includes performing an IVVP as a secondary palatal intervention. It was popularized and recommended by Sommerlad et al (1994; 2002) as a first line procedure for treatment of post-palatoplasty VPI.1,2 Our center management protocol for VPI follows a similar physiologic approach (Figure 4).
Palatal re-repair aims to improve velar function by retro-positioning the levator veli palatini muscles. The surgery includes extensive dissection, leading to tissue edema and scar formation which may need time to remodel. Together with the change of muscle orientation and tension, it is expected that a period of time is needed to reach the final functional performance. This study attempts to determine how much time is required to reach the optimum performance of the palate after re-repair.
A retrospective chart review identified consecutive cleft patients with VPI who underwent palate re-repair procedure by a single surgeon from 2000 to 2015 and achieved normal or borderline normal VP function. Only patients who had regular postoperative follow-up visits for speech assessments until resolution of speech abnormalities were included. The percent of patients cured at each time point following surgery was recorded.
Forty-five patients met the inclusion criteria. The mean age at surgery was 6.6 ± 3.2 years. Speech abnormalities had resolved in 44.5% of patients within the first 6 months after surgery, 62.2% after up to 1 year, 75.6% after up to 2 years and 88.9% after up to 3 years post re-repair palatoplasty. The remaining 11.1% continued to improve after 3 years up to 6 years.
Re-repair procedures may take a longer time than previously thought for the final outcome to manifest. Close monitoring of improvement with continued speech therapy is recommended before deciding to move to the next surgical step in management.
Change in quality of life after treatment of mild velopharyngeal insufficiency with autologous fat transplantation
2017, JPRAS Open
Citation Excerpt :
The patients born with a cleft palate (±cleft lip) before 1993 had undergone palate repair as described by von Langenbeck.20 The patients born in 1993 and later had undergone a palate repair with an intra-velar veloplasty, as described by Sommerlad,21 between 12 and 15 months of age. One patient had undergone a pharyngoplasty (superior pharyngeal flap) 20 years prior to autologous fat transplantation operation.
Autologous fat transplantation has been used to treat mild velopharyngeal insufficiency (VPI) for the last two decades. The effectiveness of this technique has been evaluated by assessing speech and measuring velopharyngeal closure. Few studies have considered the subjective opinion of the patient and their parents. This study aimed to evaluate the quality of life (QOL) of patients who had undergone fat transplantation using a validated questionnaire, VPI Effects on Life Outcome (VELO).
Two copies of the questionnaire VELO were administered to 26 patients with mild VPI who had undergone fat transplantation between 2006 and 2015. All patients were nonsyndromic, and 17 of them had cleft palate. All clefts had been repaired prior to fat transplantation. Both patients and their parents, for those younger than 18 years, completed two questionnaires each: the first one referred to the preoperation QOL, while the second one referred to the current QOL.
The total score and “Speech limitations,” “Situational difficulty,” and “Emotional impact” subscores improved significantly (p < 0.005) when assessed by the patients. A significant improvement was also observed in the total score and “Speech limitations” subscore when assessed by the parents (p = 0.008). A significant improvement in QOL was found in cleft palate patients (p = 0.004). Better improvement in QOL was found in patients who had undergone fat transplantation more than 3 years ago (p = 0.001) and in those who had undergone only one procedure (p = 0.009).
Fat transplantation to the velopharynx improves the QOL in patients with mild VPI.

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Cleft palate re-repair—a clinical and radiographic study of 32 consecutive cases

Abstract

Br J Plast Surg

Br J Plast Surg

Br J Plast Surg

Pharyngoplasty

Videofluoroscopic studies of speech in patients with cleft palate