Wide palatal cleft increases risk for postoperative speech problems
MedWire News: Children with a wide palatal cleft have an increased risk for developing velopharyngeal insufficiency (VPI) after surgery compared with those with a smaller cleft, show study results.
VPI, resulting in hypernasal speech and escape of nasal air during speech, as well as nasopharyngeal reflux on swallowing, occurs commonly after cleft palate repair.
To investigate factors that may predispose a patient to VPI following surgery, Derek Lam (Cincinnati Children's Hospital Medical Center, Ohio, USA) and colleagues carried out a retrospective cohort study of 61 patients with isolated cleft palate who underwent surgery to repair their clefts between 2003 and 2008. The mean age of the children at surgery was 13 months and the fistula rate was 3%.
Writing in the Archives of Facial Plastic Surgery, Lam and team report that 32% of the children developed VPI after their operation.
A major factor associated with risk for VPI was increasing age at surgery, with each additional month in age increasing the risk for postsurgical VPI 1.4 fold.
Cleft width was another important factor. Following adjustment for cleft length, patient age, and presence of an associated syndrome, children who had a cleft width greater than 10 mm had a 4.5-fold increased risk for VPI following surgery compared with those with a smaller cleft width.
"The high rate of VPI among patients with clefts at least 10 mm in width suggests that in patients with isolated palatal clefts wider than 10 mm, there should be careful consideration of strategies to minimize post-operative VPI," say the researchers.
"This would include the use of lengthening procedures such as the Furlow palatoplasty, and in some cases, one might even consider procedures to correct VPI such as a pharyngeal flap or sphincter pharyngoplasty at the time of primary palate repair."
The team notes that their findings can only be applied to patients with Veau type 2 clefts, as patients with other types of clefts were not included in the analysis. Also, only Furlow palatoplasty or Furlow and V-Y pushback palatoplasties were carried out in these patients.
"Future prospective studies investigating the impact of cleft width on postoperative VPI should include other cleft types and other methods of repair to allow greater generalization," they conclude.
By Helen Albert