Current Practices and Controversies in Management of the Submucous Cleft Palate

2016 ◽  
Vol 1 (5) ◽  
pp. 59-69 ◽  
Author(s):  
Lynn Marty Grames ◽  
Kamlesh Patel
Keyword(s):  
Cleft Palate ◽  
Surgical Repair ◽  
Consensus Conference ◽  
Velopharyngeal Insufficiency ◽  
Specific Information ◽  
Methods Of Evaluation ◽  
Submucous Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Definition Of

A review of the published literature on submucous cleft palate was conducted. Specific information sought included definition and prevalence of submucous cleft palate, indications for surgical intervention, ideal age for intervention, evaluation tools for submucous cleft palate, and whether or not surgical repair was indicated for treatment of velopharyngeal insufficiency, feeding issues, or ear disease associated with submucous cleft. The research revealed that there is no consistent definition of submucous cleft palate in the published literature, which renders comparison of treatments difficult. In addition, the literature lacks consensus on the indications for submucous cleft palate repair, the effect of repair on ancillary disorders that may exist, and the best methods of evaluation for submucous cleft palate. A consensus conference on the submucous cleft may be valuable in guiding treatment and research going forward.

scholarly journals Vomer Agenesis as a Rare Cause of Hypernasality

2018 ◽  
Vol 5 ◽  
Author(s):  
Adam Mohamad ◽  
Rohaida Ibrahim ◽  
Khairul Azhar Mohd Rajet ◽  
Irfan Mohamad ◽  
Anura Aman
Keyword(s):  
Cleft Palate ◽  
Surgical Complication ◽  
Nasolacrimal Duct ◽  
Neuromuscular Disorder ◽  
Velopharyngeal Insufficiency ◽  
Air Emission ◽  
Submucous Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Rare Symptom

Hypernasality which is rare symptom commonly occur as a consequence of velopharyngeal insufficiency (VPI). VPI usually manifested as nasal air emission and hypernasal resonance during speech. The cause can be divided into congenital, neuromuscular disorder and surgical complication. Congenital cause of VPI includes cleft palate, nasal septum malformation such as vomer agenesis, submucous cleft palate and velar dysplasia, while neuromuscular VPI can be due to cerebral palsy or cerebrovascular accident. Surgical cause of VPI could be due to adenoidectomy and scarring of the velum post palatoplasty in cleft palate repair. We present a 17-year-old man who was diagnosed of congenital left nasolacrimal duct obstruction referred to us for left endoscopic dacrocystorhinostomyin which during nasoendoscopic examination revealed absence of vomer.

Incidence of Oronasal Fistulae and Velopharyngeal Insufficiency after Cleft Palate Repair: An Audit of 211 Children Born between 1990 and 2004

2008 ◽  
Vol 45 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Yun Shan Phua ◽  
Tristan de Chalain
Keyword(s):  
Cleft Palate ◽  
Surgical Repair ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Oronasal Fistula ◽  
Future Performance ◽  
Cleft Palate Repair ◽  
Study Population ◽  
Palate Repair

Objective: We present an audit of primary cleft palate surgery at our unit, including rates of oronasal fistula development, speech outcomes, and rates of velopharyngeal insufficiency requiring secondary surgery. Design: A retrospective study of patients with all cleft palate types, born between January 1990 and December 2004, who underwent primary palatoplasty at Middlemore Hospital, Auckland, New Zealand. Patients: The study included 211 patients, collectively operated on by five different surgeons. Results: The overall rate of true fistula development was 12.8% over a mean follow-up period of 4 years 10 months. The incidence of true fistulae that required surgical repair was 8.1%. Fistula rates were higher for more severe degrees of clefting but were not affected by gender or type of surgical repair. Overall, 31.8% of the study population had some degree of hypernasality following primary palatoplasty. Secondary surgery for velopharyngeal insufficiency was required in 13.3% of patients. Following surgical correction of velopharyngeal insufficiency, no patients were reported to have appreciable hypernasality and 21.7% were reported to have mild hypernasality, a result comparable to previously published audits. The requirement for secondary surgery was higher in patients with more severe clefts. Conclusion: Our results are comparable to other recent studies. We believe that highly coordinated cleft care helps ensure such outcomes. These data provide a benchmark against which we can measure future performance in our attempts to improve outcomes of cleft repair.

Cleft Palate

2018 ◽  
Author(s):  
Oksana A Jackson ◽  
Alison E Kaye ◽  
David W Low
Keyword(s):  
Cleft Palate ◽  
Normal Function ◽  
Speech Development ◽  
Velopharyngeal Insufficiency ◽  
Surgical Interventions ◽  
Feeding Difficulties ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Impaired Speech

A cleft of the palate represents one of the most common congenital anomalies of the craniofacial region. Palatal clefting can occur in combination with a cleft of the lip and alveolus or as an isolated finding and can vary significantly in severity. The intact palate is a structure that separates the oral and nasal cavities, and the function of the palate is to close off the nasal cavity during deglutition and to regulate the flow of air between the nose and mouth during speech production. An unrepaired cleft palate can thus result in nasal regurgitation of food and liquid, early feeding difficulties, and impaired speech development. The goals of surgical repair are to restore palatal integrity by closing the cleft defect and repairing the musculature to allow for normal function during speech. The secondary goal of cleft palate repair is to minimize deleterious effects on growth of the palate and face, which can be impacted by standard surgical interventions. This review describes two of the most commonly performed cleft palate repair techniques in use today, as well as highlighting special anatomic considerations, summarizing perioperative care, and reviewing postoperative complications and their management. This review contains 11 figures, 2 videos, 3 tables and 63 references Key words: cleft, cleft team, Furlow, orofacial, oronasal fistula, palatoplasty, speech, submucous cleft, velopharyngeal insufficiency

Effects of Cleft Width and Veau Type on Rates of Palatal Fistula and Velopharyngeal Insufficiency after Cleft Palate Repair

2012 ◽  
Vol 130 ◽  
pp. 23 ◽  
Author(s):  
Nance Yuan ◽  
Amir H. Dorafshar ◽  
Keith E. Follmar ◽  
Courtney Pendleton ◽  
Richard J. Redett
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Palatal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

The effects of palatal lengthening on the functional and speech outcomes after submucous cleft palate repair

2016 ◽  
Vol 70 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Abdelrahman Ezzat ◽  
Marwa El-Begermy ◽  
Mustafa Eid ◽  
Mabrouk Akel
Keyword(s):  
Cleft Palate ◽  
Submucous Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

scholarly journals Speech Outcome Evaluation After Two-Flap Palatoplasty In Plastic Surgery Division Cipto Mangunkusumo Hospital: A Retrospective study

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Kristaninta Bangun ◽  
Siti Handayani ◽  
Intania Djoenaedi ◽  
Luh Karunia Wahyuni
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Surgical Repair ◽  
Outcome Evaluation ◽  
Analysis Study ◽  
Speech Pathologist ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Larger Sample ◽  
Normal Speech

One of the primary goal of cleft palate repair is to provide an intact mechanism for normal speech production. The purpose of this study is to evaluate the two-flap mucoperiosteal palatoplasty procedure on speech outcomes in patients undergoing surgical repair before the age of 2 years. A retrospective analysis study was done on 22 children with complete unilateral cleft palate (with or without cleft lip) who underwent two-flap palatoplasty between year 2002 to 2006 at Cipto Mangunkusumo Hospital. Evaluation was performed by a speech pathologist for pattern of articulation, hypernasality, intelligibility, and velopharyngeal competence. Palatoplasty were performed after 2 year-old in 11 patients and before 2 year-old in 11 patients. Speech of the 22 children postpalatoplasty was evaluated perceptually from standardised tape recordings. Velopharyngeal competence in patients who underwent palatoplasty before 2 year-old compared to after 2 year-old were 72.7% good, 18.2% fair and 9.1% poor versus 54,5% good, 9,1% fair and 36,4% poor respectively. Two-flaps mucoperiosteal palatoplasty performed before the age of 2 years old shows better spepolech outcome in all parameters, although the numbers are not statistically significant. Further prospective study with larger sample is needed.

Dentoalveolar Arch Dimensions in UCLP Boys After Neonatal Cheiloplasty or After Lip Surgery at the Age of 3 or 6 Months

2019 ◽  
Vol 56 (8) ◽  
pp. 1020-1025 ◽  
Author(s):  
Magdalena Kotova ◽  
Wanda Urbanova ◽  
Andrej Sukop ◽  
Renata Peterkova ◽  
Miroslav Peterka ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Control Group ◽  
Arch Width ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Deciduous Molars ◽  
Plaster Casts

Objective: To compare the influence of 3 different time protocols of cleft lip and palate operations on the growth of the dentoalveolar arch in patients with unilateral cleft lip and palate (UCLP). Materials and Methods: We evaluated 64 plaster casts of 8-year-old boys with UCLP operated on according to 3 different time protocols: lip repair at the age of 6 months and palate repair at 4 years, lip repair at 3 months and palate repair at 9 months, and neonatal lip repair and palate repair at 9 months. The control group contained 13 plaster casts of 8-year-old boys. The dentoalveolar arch width was measured between deciduous canines and between the second deciduous molars; the length was measured between incisive papilla and the line connecting both tuber maxillae. Results: All measured distances were statistically significantly smaller in boys with UCLP than in the control group. Intercanine width was not statistically significantly different between the patients operated on according to the different time protocols. In comparison to the lip repair at 6 months and palate repair at 4 years, the intermolar width was statistically significantly smaller in the group with neonatal lip repair; the alveolar arch length was statistically significantly shorter in both groups with lip repair performed neonatally or at 3 months. Conclusions: The length of the dentoalveolar arch is shorter after surgical repair of cleft lip neonatally or at the age of 3 months. Cleft palate repair at 9 months can contribute to a reduction in the width of the dentoalveolar arch.

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

Sign in / Sign up

Export Citation Format

Share Document