Frequency of Pharyngoplasty
after Primary Repair of Cleft Palate
FULL TEXT
Sean Bicknell
Leland R. McFadden, DDS, MSc, FRCD(C)
John B. Curran, BDS, FFDRCS(IREL), FRCD(C)
A b s t r a c t
Background: The frequency of pharyngoplasty after initial repair of cleft palate is a direct measure of the success or failure of the primary palatal repair with respect to velopharyngeal function. The optimal timing and surgical technique for the repair of cleft palate remain subjects of debate.
Purpose: To assess the outcome of various techniques for primary palatal repair, speci.cally the frequency of secondary pharyngoplasty, and to determine the signi.cance, if any, of certain variables to this outcome.
Methods: A pool of 114 patients with cleft lip and palate was compiled from a retrospective analysis of medical records for more than 300 consecutive patients treated over a 15-year period (19801995). The review included only patients who had been treated by the same surgeon or by his resident. A 1-stage palatal repair was performed on all patients, in which the hard and the soft palate were closed simultaneously. The following data were collected: patient's sex, patient's date of birth, type of cleft, technique used for initial repair, age at initial repair and date of secondary pharyngoplasty surgery, if performed.
Results: The overall frequency of subsequent pharyngoplasty was 25% (28 patients). The rate of secondary surgery was signi.cantly higher for boys (21/63 or 33%) than for girls (7/51 or 14%). There were also significant differences in the rate of secondary pharyngoplasty according to type of cleft: 50% (6/12) for patients with bilateral cleft lip and palate, 44% (7/16) for those with hard and soft cleft palate, 21% (8/38) for those with unilateral cleft lip and palate, 20% (3/15) for those with submucous cleft palate and 12% (4/33) for those with soft cleft palate. Surgical technique for the primary repair (V-Y pushback or von Langenbeck procedure) was not a signi.cant factor in determining the rate of subsequent pharyngoplasty, nor was age at primary repair, although those who underwent primary repair at age 1214 months were least likely to require pharyngoplasty.
Conclusion: In this study the frequency of velopharyngeal insufficiency after 1-stage palatoplasty was consistent with previously reported results. Of interest would be a comparison of 1-stage and 2-stage approaches to primary palate repair in young patients.
MeSH Key Words: cleft palate/surgery; cleft palate/complications; velopharyngeal insufficiency
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