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.

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

2021 ◽  
Vol 58 (5) ◽  
pp. 603-611
Author(s):  
Giap H. Vu ◽  
Christopher L. Kalmar ◽  
Carrie E. Zimmerman ◽  
Laura S. Humphries ◽  
Jordan W. Swanson ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Charge Ratio ◽  
Fistula Repair ◽  
Case Volume ◽  
Secondary Surgery ◽  
Hospital Case ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

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

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.

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

Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair

2021 ◽  
pp. 105566562110295
Author(s):  
Åsa C. Okhiria ◽  
Fatemeh Jabbari ◽  
Malin M. Hakelius ◽  
Monica M. Blom Johansson ◽  
Daniel J. Nowinski
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
The Impact ◽  
Nasal Emission

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

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

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.

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.

scholarly journals BILATERAL CLEFT PALATE REPAIR BY USING TONGUE FLAP FOLLOWED BY ALVEOLAR BONE GRAFTING - A CASE REPORT

2021 ◽  
Vol 71 (1) ◽  
pp. 370-72
Author(s):  
Memuna Kausar Satti ◽  
Zainab Qasim ◽  
Farwa Rais ◽  
Ayousha Iqbal ◽  
Maahin Shoaib ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Postoperative Results ◽  
Tongue Flap ◽  
Alveolar Bone Grafting ◽  
Cleft Palate Repair ◽  
Palate Repair

A clinical case of bilateral cleft palate repair using previous tongue flap followed by Alveolar Bone Grafting(ABG). After pre-surgical orthodontics a surgical procedure whereby previous tongue Flaps were reflected, nasalbeds were prepared on both sides. A cortico-cancellous bone of 2 cm was harvested from iliac crest and grafted inclefts. Patient is kept on follow up to monitor healing, postoperative results and any post- operative complication.

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