‘Suspension Palatoplasty’ - A new Method of Primary Palate Repair for Speaking Un-Repaired Clefts

Abstract

Objective

To design a technique of palate repair with predictable Velo Pharyngeal (VP) closure and normal speech - ‘Suspension Palatoplasty’ in speaking unrepaired Cleft Palate (CP) patients. To evaluate the results of patients with CP operated using the technique of ‘Suspension palatoplasty’ from 2014 −2018 in terms of surgical complications and speech outcomes.

Design

An ambi-spective longitudinal clinical study.

Setting

Comprehensive cleft care clinic in a private trust hospital.

Patients/ Participants

Patients above 6 years of age with isolated CP, cleft lip and palate (CLP), operated using ‘Suspension Palatoplasty’ technique between 2014 and 2018 were included with minimum follow up period of 5 years. Subjective speech evaluation was done by two speech therapists and analysed.

Intervention

Author designed the technique of ‘Suspension Palatoplasty’ which aims to suspend the soft palate repaired by ‘Hybrid Palatoplasty’ technique, close to the nasopharynx using narrow pharyngeal flap with the pedicle based superiorly at adenoids, for an acceptable VP closure.

Main Outcome Measures

Speech outcome and surgical complications were assessed.

Results

Out of 94 cases operated with age ranging from 6 to 45 years, 59 (62.8%) had normal speech, 12 (12.8%) had articulation errors but with no Velo-Pharyngeal Insufficiency (VPI) and 23 patients (24.4%) had hypernasality/ nasal emission (Suspected VPI). None of them had difficulty in breathing but one patient had snoring.

Conclusion

‘Suspension Palatoplasty’ is a simple primary operation with excellent speech outcomes with no obstructive sequelae in patients with speaking unrepaired cleft palate.

Keywords

cleft palate pharyngoplasty palatoplasty soft palate speech disorders velopharyngeal dysfunction

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