Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

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Results of Randomized Controlled Trial of Soft Palate First versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-065.1 ◽

2006 ◽

Vol 43 (3) ◽

pp. 329-338 ◽

Cited By ~ 30

Author(s):

Bruce Richard ◽

Joyce Russell ◽

Siobhan McMahon ◽

Ron Pigott

Keyword(s):

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Primary Repair ◽

Controlled Trial ◽

Facial Growth ◽

Cleft Closure ◽

Palate Repair ◽

Intercanine Distance

Objective To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first. Design Randomized controlled trial. Setting The Regional Cleft Service of West Nepal. Patients Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair. Interventions Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later. Main Outcome Measures Analysis of dental study models, weight gain, and speech recordings. Results Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation. Conclusion Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

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A Comparison of Three Methods of Repairing the Hard Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0383_acotmo_2.0.co_2 ◽

2002 ◽

Vol 39 (4) ◽

pp. 383-391 ◽

Cited By ~ 20

Author(s):

R. W. Pigott ◽

E. H. Albery ◽

I. S. Hathorn ◽

N. E. Atack ◽

A. Williams ◽

...

Keyword(s):

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Small Sample Size ◽

Statistical Significance ◽

Small Sample ◽

Velopharyngeal Insufficiency ◽

Strong Trend ◽

Computer Based ◽

Palate Repair

Objective To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. Patients Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. Interventions Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. Outcome Measures For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. Results There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p = .01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. Conclusions Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

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Results of Randomized Controlled Trial of Soft Palate First Versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-065 ◽

2005 ◽

Author(s):

Bruce Richard ◽

Joyce Russell ◽

Siobhan McMahon ◽

Ron Pigott

Keyword(s):

Randomized Controlled Trial ◽

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Controlled Trial ◽

Randomized Controlled

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Do Infant Cleft Dimensions Have an Influence on Occlusal Relations? A Subgroup Analysis Within an RCT of Primary Surgery in Patients With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619875320 ◽

2019 ◽

Vol 57 (3) ◽

pp. 378-388

Author(s):

Susanna Botticelli ◽

Annelise Küseler ◽

Agneta Marcusson ◽

Kirsten Mølsted ◽

Sven E. Nørholt ◽

...

Keyword(s):

Soft Palate ◽

Subgroup Analysis ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

3D Analysis ◽

Primary Surgery ◽

Size And Morphology ◽

Crude Analysis ◽

Closure Group

Aim: To investigate whether infant cleft dimensions, in a surgical protocol with early or delayed hard palate closure, influence occlusion before orthodontics. Design: Subgroup analysis within a randomized trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical centre. Patients and Methods: A total of 122 unilateral cleft lip and palate infants received primary cheilo-rhinoplasty and soft palate closure at age 4 months and were randomized for hard palate closure at age 12 versus 36 months. A novel 3D analysis of cleft size and morphology was performed on digitized presurgical models. Occlusion was scored on 8-year models using the modified Huddarth–Bodenham (MHB) Index and the Goslon Yardstick. Main Outcome Measurements: Differences in MHB and Goslon scores among the 2 surgical groups adjusted for cleft size. Results: The crude analysis showed no difference between the 2 surgical groups in Goslon scores but a better MHB ( P = .006) for the group who received delayed hard palate closure. When adjusting for the ratio between cleft surface and palatal surface (3D Infant Cleft Severity Ratio) and for posterior cleft dimensions at tuberosity level, the delayed hard palate closure group received 3.65 points better for MHB (confidence interval: 1.81; 5.48; P < .001) and showed a trend for reduced risk of receiving a Goslon of 4 or 5 ( P = .052). For posterior clefts larger than 9 mm, the Goslon score was better in the delayed hard palate closure group ( P = .033). Conclusions: Seen from an orthodontic perspective, when the soft palate is closed first, and the cleft is large, the timing of hard palate closure should be planned in relation to posterior cleft size.

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Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619829388 ◽

2019 ◽

Vol 56 (8) ◽

pp. 1008-1012 ◽

Cited By ~ 1

Author(s):

Alistair G. Smyth ◽

Jianhua Wu

Keyword(s):

Cleft Palate ◽

Retrospective Cohort ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Prognostic Impact ◽

Palatal Fistula ◽

Primary Surgery ◽

Cleft Palate Repair ◽

Palate Repair ◽

Velopharyngeal Function

Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function. Design: A retrospective cohort study. Setting: A regional specialist cleft lip and palate center within United Kingdom. Patients, Participants: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria. Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release. Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age. Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; P < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%). Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.

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Long-Term Evidence for Favorable Midfacial Growth after Delayed Hard Palate Repair in UCLP Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2001_038_0323_lteffm_2.0.co_2 ◽

2001 ◽

Vol 38 (4) ◽

pp. 323-329 ◽

Cited By ~ 37

Author(s):

Hans Friede ◽

Hans Enemark

Keyword(s):

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Good Alternative ◽

Speech Development ◽

Mixed Dentition ◽

Surgical Methods ◽

Palate Repair

Objective: To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with “conventional” surgical methods of palatal closure. Design and Setting: Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. Patients: Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. Results and Conclusions: Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.

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Results of Randomized Controlled Trial of Soft Palate First Versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-065r.1 ◽

2006 ◽

Vol 43 (3) ◽

pp. 329 ◽

Cited By ~ 5

Author(s):

Bruce Richard ◽

Joyce Russell ◽

Siobhan McMahon ◽

Ron Pigott

Keyword(s):

Randomized Controlled Trial ◽

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Controlled Trial ◽

Randomized Controlled

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Impact of cleft palate repair on speech and development of dentoalveolar deformities

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2021-3-47-53 ◽

2021 ◽

Vol 16 (3) ◽

pp. 47-53

Author(s):

Yu.V. Stebeleva ◽

◽

Ad.A. Mamedov ◽

Yu.O. Volkov ◽

A.B. McLennan ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Techniques ◽

Normal Functioning ◽

Primary Surgery ◽

Cleft Palate Repair ◽

Congenital Cleft ◽

Palate Repair ◽

Late Postoperative Period

Surgical repair of cleft palate is quite difficult because it aims not only to eliminate the anatomical defect of the palate, but also to ensure normal functioning, including speech. Moreover, successful surgery implies no or minimal deformation of the middle face that can be corrected in the late postoperative period. No doubt that primary surgery (both in terms of technique and time) is crucial for further growth and development of the maxilla. However, surgical techniques and the age of primary cleft palate repair vary between different clinics, which makes this literature review highly relevant. Key words: cleft palate repair, cleft palate, congenital cleft lip and palate

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Hard Palate Repair Timing and Facial Growth in Unilateral Cleft Lip and Palate: A Longitudinal Study

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-119 ◽

2006 ◽

Vol 43 (5) ◽

pp. 547-556 ◽

Cited By ~ 53

Author(s):

Yu-Fang Liao ◽

Timothy J. Cole ◽

Michael Mars

Keyword(s):

Longitudinal Study ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sri Lankan ◽

Facial Morphology ◽

Facial Growth ◽

Clinical Notes ◽

Timing Effect ◽

Palate Repair

Objective: To investigate whether timing of hard palate repair had a significant effect on facial growth in patients with unilateral cleft lip and palate (UCLP). Design: Retrospective longitudinal study. Setting: Sri Lankan Cleft Lip and Palate Project. Patients: A total of 104 patients with nonsyndromic UCLP who had hard palate repair by age 13 years, with their 290 cephalometric radiographs taken after lip and palate repair. Main Outcome Measures: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology and growth rate. Results: Timing of hard palate repair had a significant effect on the length and protrusion of the alveolar maxilla (PMP-A and SNA, respectively) and the anteroposterior alveolar jaw relation (ANB) at age 20 years but not on their growth rates. Conclusion: Timing of hard palate repair significantly affects the growth of the maxilla in patients with UCLP. Late hard palate repair has a smaller adverse effect than does early hard palate repair on the growth of the maxilla. This timing effect primarily affects the anteroposterior development of the maxillary dentoalveolus and is attributed to the development being undisturbed before closure of the hard palate.

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