Speech evaluation after repair of unilateral complete cleft palate using modified 2-flap palatoplasty.J Craniofac Surg. 2009 Jan; 20(1):111-4; discussion 115.JC
Two-flap palatoplasty using mucoperiosteal flaps is becoming popular for wide cleft palates. We found that elevation of the cleft-side mucoperiosteal flap was sufficient to close the defect without elevation or relaxing incision in the noncleft side when performing 2-flap palatoplasty for a complete unilateral cleft palate. We have termed this modified 2-flap palatoplasty. The present study compared speech after classic and modified 2-flap palatoplasty for unilateral complete cleft palate.
Of 31 unilateral complete cleft lip and palate patients, 16 underwent the classic 2-flap palatoplasty between September 1998 and September 2000, and 15 underwent modified 2-flap palatoplasty between November 2000 and November 2002. Postoperative speech evaluation was undertaken by a speech pathologist. Patients with functional speech problems such as hypernasality or compensatory articulation were recommended for speech therapy. In cases where speech therapy did not result in normal speech, patients underwent secondary velopharyngeal surgery and further speech therapy.
Fifteen of 16 patients who underwent the classic procedure were followed up, of which 5 showed hypernasality or compensatory articulation upon speech evaluation. Four of those patients required secondary velopharyngeal surgery. All 15 patients who underwent the modified procedure were followed up. Six of those patients showed hypernasality or compensatory articulation, of which 2 required secondary velopharyngeal surgery. There was no statistically significant difference between the classic and modified groups in terms of palatal fistula rate, speech, and secondary surgery rate.
There was no difference between the classic and modified 2-flap palatoplasty in terms of postoperative palatal fistula rate, speech, and secondary surgery rate. Because of the advantages of the modified procedure in terms of fewer incisions, these findings indicate that larger long-term studies are warranted, particularly to evaluate maxillary bone growth.