‘Suspension Palatoplasty’ – A method of surgical correction of VPI post Cleft Palate repair

Abstract

Objective

To design the technique of ‘Suspension Palatoplasty’ for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech.

To evaluate the results of CP patients with VPI operated using the technique of ‘Suspension palatoplasty’.

Design

An ambi-spective longitudinal clinical study.

Setting

Comprehensive cleft care clinic in a private trust hospital.

Patients, Participants

Patients operated using the ‘Suspension Palatoplasty’ technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years.

Interventions

‘Suspension Palatoplasty’ - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure.

Main outcome measure

Speech outcome and surgical complications.

Results

70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech.

Conclusion

‘Suspension Palatoplasty’ aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

Keywords

velopharyngeal dysfunction velopharyngeal insufficiency pharyngeal flap hybrid palatoplasty pharyngoplasty

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