Treatment of submucous cleft palate by pharyngeal flap as a primary procedure

Objective We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal flap that had been previously established to treat velopharyngeal insufficiency associated with a submucous cleft palate. Intervention A tonsillectomy, conducted by a surgeon unaffiliated with a cleft palate team, was used to remove enlarged tonsils that had developed after pharyngeal flap surgery and extended into the lateral ports causing nasal obstruction and hypernasality because of mechanical interference with port closure. A posttonsillectomy evaluation revealed avulsion of the pharyngeal flap, which was successfully treated using a Furlow palatoplasty. Conclusions To our knowledge, this is the first report of iatrogenic avulsion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy should not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled otolaryngologist, preferably one affiliated with a multidisciplinary cleft palate team who is familiar with pharyngoplasty surgery. Finally, our experience would suggest that the Furlow palatoplasty is sufficiently robust to be used as a secondary salvage procedure to restore velopharyngeal sufficiency following iatrogenic avulsion of a pharyngeal flap.

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Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000003408 ◽

2018 ◽

Vol 29 (1) ◽

pp. e100-e103 ◽

Cited By ~ 8

Author(s):

Mert Calis ◽

Galip Gencay Ustun ◽

Mehtap Ozturk ◽

Riza Onder Gunaydin ◽

Mavis Emel Kulak Kayikci ◽

...

Keyword(s):

Cleft Palate ◽

Submucous Cleft Palate ◽

Pharyngeal Flap ◽

Intravelar Veloplasty

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Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

The Cleft Palate-Craniofacial Journal ◽

10.1597/13-046 ◽

2014 ◽

Vol 51 (6) ◽

pp. 686-695 ◽

Cited By ~ 13

Author(s):

Onur Gilleard ◽

Debbie Sell ◽

Ali M. Ghanem ◽

Yasemin Tavsanoglu ◽

Malcolm Birch ◽

...

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Surgical Management ◽

Evidence Base ◽

Velopharyngeal Insufficiency ◽

Abnormal Development ◽

Submucous Cleft Palate ◽

Congenital Condition ◽

Pharyngeal Flap ◽

Speech Assessment

Objective Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP. Methodology Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review. Results Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment. Conclusions The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.

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Treatment of Velopharyngeal Inadequacy in a Patient with Submucous Cleft Palate and Myasthenia Gravis

The Cleft Palate-Craniofacial Journal ◽

10.1597/08-049.1 ◽

2009 ◽

Vol 46 (5) ◽

pp. 558-562 ◽

Cited By ~ 1

Author(s):

Naoaki Rikihisa ◽

Akikazu Udagawa ◽

Shinya Yoshimoto ◽

Masaharu Ichinose ◽

Tomoe Kimura ◽

...

Keyword(s):

Myasthenia Gravis ◽

Cleft Palate ◽

Flap Surgery ◽

Cleft Palate Speech ◽

Air Emission ◽

Velopharyngeal Incompetence ◽

Initial Surgery ◽

Submucous Cleft Palate ◽

Pharyngeal Flap

Objective: To describe the clinical course and management of a patient with submucous cleft palate who developed myasthenia gravis (MG) as an adult and suffered recurrent hypernasality. Few reports have described MG patients undergoing pharyngeal flap surgery for velopharyngeal incompetence, and these have described only slight speech improvement in such patients. Design: Case report. Patient: The patient underwent primary pushback palatoplasty and superiorly based pharyngeal flap surgery for submucous cleft and short palate at age 7. Hypernasality showed major improvement after initial surgery. At age 19, the patient developed MG that triggered the recurrence of velopharyngeal incompetence. Intervention: After MG was treated, revision pushback palatoplasty was performed for velopharyngeal incompetence when the patient was 24 years old. Preoperatively and postoperatively, the patient was evaluated by the same speech-language-hearing therapists, each with at least 5 years of clinical experience in cleft palate speech. Results: After the second pushback palatoplasty, hypernasality and audible nasal air emission during speech decreased to mild. Conclusion: Primary pushback palatoplasty and pharyngeal flap surgery were performed for the submucous cleft palate. Revision pushback palatoplasty improved velopharyngeal inadequacy induced by MG. Decreased perceived nasality positively influenced the patient's quality of life. Combined pushback palatoplasty and pharyngeal flap surgery is thus an option in surgical treatment for velopharyngeal inadequacy to close the cleft and the velopharyngeal orifice in cases of cleft palate and MG.

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The efficacy of transnasal palatal transillumination for the diagnosis of submucous cleft palate

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00093-9 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Yasir S. Jamal ◽

Sabah S. Moshref ◽

Abeer M. Baamir ◽

Mazin O. Kurdi ◽

Doaa Y. Jamal

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Diagnostic Techniques ◽

Lateral Release ◽

Feeding Difficulties ◽

Presenting Symptoms ◽

Submucous Cleft Palate ◽

Cheap Method ◽

Operative Findings ◽

Simple Repair

Abstract Background Submucous cleft palate (SMCP) is a congenital abnormality with various clinical and anatomical features. Submucous cleft pathologies may be unrecognized during routine examinations. Current diagnostic techniques are constrained and unrevealing in presurgical patients. This prospective study aimed to evaluate transnasal palatal transillumination technique in diagnosis of SMCP at our institute hospital, during period from 2005-2020. Patients and methods Twenty-one cases with SMCP were recruited with age range from 2-60 months. Transnasal palatal transillumination with controllable light intensity endoscope used to evaluate SMCP and cases were photo and video recorded. Results In this study, 21 cases (13 males and 8 females) with SMCP were detected or confirmed by intranasal transnasal palatal transillumination. Frequency of SMCP patients at our institute was 3.39%. All patients presented with symptomatic complaints at diagnosis time, apart from 5 patients (23.8%) were diagnosed during cleft lip repair operations. Presenting symptoms were hypernasality (23.8%), delayed speech (23.8%), perforated palate with nasal escape of milk and food (14.3%), feeding difficulties (14.3%), and otitis media (4.8%). During intra-oral examination, all cases had a bifid uvula accompanied SMCP. Submucous cleft palate appeared as thin palate with central lucency. According to operative findings, operations done for repair were mostly two long palatal flaps (n = 13, 61.9%), von Langenbeck (n = 5, 23.8%), simple repair with lateral release incisions (n = 2, 9.6%), and simple repair without lateral release incision (n = 1, 4.8%). Conclusions Intraoperative assessment of submucous cleft palate with transnasal palatal transillumination is easy and cheap method to avoid missing cases of SMCP.

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Dental anomalies frequency in submucous cleft palate versus complete cleft palate

European Journal of Orthodontics ◽

10.1093/ejo/cjab003 ◽

2021 ◽

Author(s):

João Paulo Schwartz ◽

Daniela Gamba Garib

Keyword(s):

Cleft Palate ◽

Permanent Teeth ◽

Tooth Agenesis ◽

Dental Anomalies ◽

Supernumerary Teeth ◽

Chi Square ◽

Intergroup Comparison ◽

Significant Difference ◽

Submucous Cleft Palate ◽

Isolated Cleft Palate

Summary Background/Objectives This retrospective study evaluated the prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate. Materials/Methods The sample comprised 26 individuals with submucous cleft palate (group S) and 68 individuals with complete cleft palate (group C) aged between 9 and 12 years from a single centre. Panoramic radiographs were evaluated regarding the presence of dental anomalies of number in permanent teeth. Intergroup comparison was performed using chi-square tests (P < 0.05). Results Tooth agenesis was found in 34.61 and 36.76 per cent of group S and group C, respectively. The most commonly missing teeth were the maxillary second premolar, maxillary lateral incisor, and mandibular second premolar. Supernumerary teeth were found in none and 1.47 per cent of the individuals with submucous and complete cleft palate, respectively. No statistically significant difference was found between groups for the frequency of tooth agenesis and supernumerary teeth. Limitations Only dental anomalies of number were evaluated. Conclusions/Implications Individuals with submucous and complete cleft palate showed similar prevalence for tooth agenesis and supernumerary teeth. Dental anomalies frequency seems not to be a discriminator for subphenotypes of cleft palate.

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Phonological Profile of Patients With Velopharyngeal Dysfunction and Palatal Anomalies

Journal of Speech Language and Hearing Research ◽

10.1044/2021_jslhr-20-00652 ◽

2021 ◽

pp. 1-15

Author(s):

Ariela Nachmani ◽

Muhamed Masalha ◽

Firas Kassem

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Age Groups ◽

Phonological Process ◽

Phonological Processes ◽

Process Error ◽

Submucous Cleft Palate ◽

Different Types

Purpose This purpose of this study was to assess the frequency and types of phonological process errors in patients with velopharyngeal dysfunction (VPD) and the different types of palatal anomalies. Method A total of 808 nonsyndromic patients with VPD, who underwent follow-up at the Center for Cleft Palate and Craniofacial Anomalies, from 2000 to 2016 were included. Patients were stratified into four age groups and five subphenotypes of palatal anomalies: cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP. Phonological processes were compared among groups. Results The 808 patients ranged in age from 3 to 29 years, and 439 (54.3%) were male. Overall, 262/808 patients (32.4%) had phonological process errors; 80 (59.7%) ages 3–4 years, 98 (40, 0%) ages 4.1–6 years, 48 (24.7%) 6.1–9 years, and 36 (15.3%) 9.1–29 years. Devoicing was the most prevalent phonological process error, found in 97 patients (12%), followed by cluster reduction in 82 (10.1%), fronting in 66 (8.2%), stopping in 45 (5.6%), final consonant deletion in 43 (5.3%), backing in 30 (3.7%), and syllable deletion and onset deletion in 13 (1.6%) patients. No differences were found in devoicing errors between palatal anomalies, even with increasing age. Phonological processes were found in 61/138 (44.20%) with CP, 46/118 (38.1%) with SMCP, 61/188 (32.4%) with non-CP, 70/268 (26.1%) with OSMCP, and 25/96 (26.2%) with CLP. Phonological process errors were most frequent with CP and least with OSMCP ( p = .001). Conclusions Phonological process errors in nonsyndromic VPD patients remained relatively high in all age groups up to adulthood, regardless of the type of palatal anomaly. Our findings regarding the phonological skills of patients with palatal anomalies can help clarify the etiology of speech and sound disorders in VPD patients, and contribute to general phonetic and phonological studies.

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