A Systematic Review Comparing Furlow Double-Opposing Z-Plasty and Straight-Line Intravelar Veloplasty Methods of Cleft Palate Repair

Objective: Simulation-based training is a relatively new inclusion to surgical training curricula, with promises of achieving increased competency while maximizing patient safety. Cleft palate, which contributes significantly to the global burden of surgically treatable diseases, is a challenging repair to learn due to the high level of skill and dexterity required, delicate oral tissues, and limited space of an infant oral cavity. Simulation training can allow cleft palate education to move from an observational to a competency-based learning. Hence, this systematic review presents the models described in the literature that simulate cleft palate repair. Design: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search of the MEDLINE and Cochrane databases was performed. Qualitative data were extracted, and the models were stratified based on their anatomical fidelity and realism, forming the basis of the curriculum. Results: The database search returned 3261 articles. Twelve articles were considered eligible for inclusion. The anatomical fidelity, human tissue likeness, evidence of improved outcomes, and cost are discussed. Conclusions: Cleft palate is a globally significant birth defect and its repair is a difficult procedure to learn. This review presents the 12 models of cleft palate described in the literature, highlighting the advances and gaps in current cleft palate simulation.

Download Full-text

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621989139 ◽

2021 ◽

pp. 105566562198913

Author(s):

Sophie Butterworth ◽

Emma L. Hodgkinson ◽

David C.G. Sainsbury ◽

Peter D. Hodgkinson

Keyword(s):

United Kingdom ◽

Surgical Technique ◽

Cleft Palate ◽

Thematic Analysis ◽

Maxillofacial Surgery ◽

Oral And Maxillofacial Surgery ◽

The United Kingdom ◽

Cleft Palate Repair ◽

Palate Repair ◽

Intravelar Veloplasty

Background: Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. Objective: To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). Design: An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. Method: A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. Results: Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme—Surgical Variation—is discussed. Conclusions: The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.

Download Full-text

Do patients with isolated Pierre Robin Sequence have worse outcomes after cleft palate repair: A systematic review

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.04.015 ◽

2015 ◽

Vol 68 (8) ◽

pp. 1095-1099 ◽

Cited By ~ 2

Author(s):

Teng Wan ◽

Yang Chen ◽

Guomin Wang

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Cleft Palate Repair ◽

Palate Repair ◽

Pierre Robin

Download Full-text

Controversies in cleft palate repair—a systematic review

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2007.08.117 ◽

2007 ◽

Vol 36 (11) ◽

pp. 992

Author(s):

N.A. de Silva Amaratunga

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Cleft Palate Repair ◽

Palate Repair

Download Full-text

Is the Use of Opioids Safe after Primary Cleft Palate Repair? A Systematic Review

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000003355 ◽

2021 ◽

Vol 9 (1) ◽

pp. e3355

Author(s):

Percy Rossell-Perry ◽

Carolina Romero-Narvaez ◽

Ruth Rojas-Sandoval ◽

Paula Gomez-Henao ◽

Maria Pia Delgado-Jimenez ◽

...

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Cleft Palate Repair ◽

Palate Repair

Download Full-text

Structure of the Musculus Uvulae: Functional and Surgical Implications of an Anatomic Study

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0466_sotmuf_2.3.co_2 ◽

1997 ◽

Vol 34 (6) ◽

pp. 466-474 ◽

Cited By ~ 21

Author(s):

Martin H. S. Huang ◽

S. T. Lee ◽

K. Rajendran

Keyword(s):

Cleft Palate ◽

Posterior Pharyngeal Wall ◽

Anatomic Study ◽

Pharyngeal Wall ◽

Cleft Palate Repair ◽

Palate Repair ◽

Velopharyngeal Function ◽

Intravelar Veloplasty ◽

Anatomic Information

Objective: The role of the musculus uvulae in velopharyngeal function, its morphologic status in cleft palate, and its fate in palatoplasty procedures are subjects of controversy. The aims of this investigation were to re-examine this velar muscle to clarify its anatomic characteristics, to analyze its role in speech physiology, and to study the surgical implications of this information for cleft palate repair. Methods: Its attachments, morphology, and relations were examined in 18 fresh human adult cadavers by detailed dissection under 3.2× magnification and light microscopy. Results: The musculus uvulae was observed to be a paired midline muscle extending between the tensor aponeurosis anteriorly and the base of the uvula posteriorly along the nasal aspect of the velum. It had no attachments to the hard palate. Conclusions: These findings suggest that its action is to increase midline bulk on the nasal aspect of the velum, thus contributing to the levator eminence. It may also have an extensor effect on the nasal aspect of the velum, displacing it toward the posterior pharyngeal wall. Both of these actions would serve to maximize midline velopharyngeal contact. One clinical application of this anatomic information is that the muscle should be preserved in the dissection performed during intravelar veloplasty. Furthermore, it should be recognized that the musculus uvulae is invariably divided and reoriented incorrectly in the Furlow double opposing Z-plasty.

Download Full-text

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619856243 ◽

2019 ◽

Vol 56 (10) ◽

pp. 1302-1313

Author(s):

Ana Tache ◽

Maurice Y. Mommaerts

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Oronasal Fistula ◽

Type Iv ◽

Cleft Palate Repair ◽

Palate Repair ◽

Fistula Rate

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

Download Full-text