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Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand.Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist.Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velopharyngeal mechanism 52.5%. Among the velopharyngeal incompetence group, articulation disorder was the most common disorder with median score of 3. Besides, the median scores for hypo/hyper-nasality, nasal emission, phonation, and facial grimace disorder were 1, 2, 0 and 0, respectively. There was no statistically significant association between velopharyngeal incompetence and cleft types, age at primary surgery, type of operation, the width of cleft palate and prevalence of postoperative oronasal fistula or otitis media effusion.Conclusion: Velopharyngeal incompetence has been commonly identified after cleft palate repair in our institute. The articulation disorder is the most common characteristic.

The children with Pierre Robin Sequence (PRS) have anatomical and physiological challenges of airwaymanagement. The children with PRS have difficult airway caused by micrognathia, glossoptosis, andcleft palate. The patients’ airway management who have PRS is dificult and requires attention. Herewe present a 5-year-old girl with PRS, admitted to our hospital for cleft palate repair surgery. She alsohad a history of traсheostomy. Otholaryngologists had to perform trachestomy for this operation. Thepatient had an uneventful operative and postoperative period. We wanted to discuss the difficulties ofairway management of the children with PRS with this case report. Anaesthesiologists must be readyfor the challenges and otholaryngologists, must also be ready to manage these difficult airways. Inaddition, bronchospasm and airway obstruction after extubation are very common complications, socareful postoperative monitoring should be performed., Pierre Robin Sendromlu (PRS) çocukların hava yolu yönetiminde anatomik ve fizyolojik zorluklarvardır. PRS’lu çocuklarda, zor havayoluna sebep olan, mikrognati, glossopitozis vardır. PRS’luhastalarda havayolu yönetimi zordur ve dikkat gerektirir. Burada PRS’lu 5 yaşında bir kız çocuğu,yarık damak onarımı için hastanemize başvuran bir hastayı sunuyoruz. Ayrıca hastanın trakeostomiöyküsü de vardı. Bu operasyon için, kulak-burun-boğaz uzmanlarının trakeostomi açması gerekti.Hastanın operasyon ve operasyon sonrası dönemi sorunsuz geçti. Bu olgu sunumu ile PRS’luhastaların havayolu zorluklarını gözden geçirmek istedik. Anestezistler, zorluklar için hazır olmalıdırve kulak burun boğaz uzmanları da bu zorlukların üstesinden gelinmesi için hazır bulunmalıdırlar. Ekolarak, bronkospazm ve havayolu tıkanıklıkları ekstübasyon sonrası sık görülen komplikasyonlardır, bunedenle dikkatli postoperatif monitörizasyon uygulanmalıdır.

Background: The main goal in the management of patients with cleft palate is anatomical closure of the defect, normal speech development, maxillofacial growth, and hearing without any complications. Cleft palate repair can be done using a variety of surgical techniques. one-stage repair is one of the commonest. Aim of work: The objective of this study is to illustrate the frequency of fistula and fistula predictors in the closure of complete cleft palate with radical palate muscle dissection in a single-stage Patients and methods: A prospective cohort study conducted on 20 patients who underwent cleft palate closure as one-stage repair in children aged between 9 months to 5 years old. Results: Twenty patients had a one-stage cleft palate repair with radical muscle dissection. The overall occurrence of fistula formation was zero. Conclusion: Anatomical repair of levator vile palatine muscle with complete dissection & releasing it from its abnormal insertion in a defect of 10-12 mm could be an important factor for limitation of fistulae incidence after cleft palate repair.

BACKGROUND: This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims. METHODS: Children under 4 years of age undergoing palatoplasty were identified in the IBM® MarketScan® Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10–14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models. RESULTS: 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09–0.39, p10–14 months (adjusted HR 0.40, 95%CI 0.31–0.52, p 14 months (adjusted HR 0.71, 95%CI 0.57–0.88, p=0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty. CONCLUSIONS: In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.

Background: Buccinator myomucosal flap and levator muscle repositioning is an alternative technique in the man-agement of velopharyngeal insufficiency secondary to cleft palate repair. Aim of Study: The goal of this study is to assess the effectiveness of the buccinators myomucosal flap and levator muscle repositioning in the management of velopharyngeal insufficiency secondary to cleft palate. Patients and Methods: A prospective study was done on thirty patients who have velopharyngeal insufficiency after cleft palate repair and recommended for surgery by the pho-niatrician. The period of the study was between August 2017 and August 2019. All cases were evaluated for speech assess-ment and videofluroscopy before the operation and 3 months after the operation. Successful speech outcome was defined as completely improved, improved, and not improved. Results: Overall improvement of the speech was obtained in 25 cases (83%) Nine of them (30%) were completely improved, 16 of them (53%) were improved by at least one grade, 5 cases (17%) showed no improvement. Conclusion: Buccinator myomucosal flap and levator muscle repositioning is a reliable efficient procedure for the management of VPI secondary to the cleft palate with minimal complications.

Objective: Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks. Design: Retrospective review of primary palatoplasty patients from 2007 to 2013. Setting: Tertiary care children’s hospital. Main Outcome Measures: We created a novel conceptual quality metric called “OOR” (Optimal Outcome Reporting). Optimal Outcome Reporting is designed to reflect the percentage of patients with cleft palate who experience the best outcomes: one operation, velar competence by age 5 years, and no unintended palatal fistula. Results: Optimal Outcome Reporting was 72.3% (68/94). Eight patients had “suboptimal” outcomes for having undergone more than one operation. Eighteen patients failed for velar incompetence. No additional patients fell out of the algorithm for fistula. A significantly higher proportion of nonsyndromic patients demonstrated an “optimal” result compared to syndromic patients (61/80, 76.3% vs 7/14, 50.0%; P = .04). Patients who required more than one procedure had significantly more clinic visits (32.6 vs 14.9; P < .01) and accrued higher costs compared to “optimal” patients (US$34 019.88 vs US$15 357.25; P < .01). Conclusions: Optimal Outcome Reporting represents a novel quality metric that can provide meaningful information for patients with cleft palate. Optimal Outcome Reporting utilization can help cleft centers adopt changes that matter to patients and their families. By allowing for cross-institutional comparisons in a clear and objective manner, OOR can promote competition, innovation, and value in cleft palate care.

Introduction Cleft lip and cleft palate are among the most common birth defects. These deformities lead to profound psychosocial and functional effects on cleft palate patients. Several surgical techniques have been described for the repair of the cleft. The defects lateral to mucoperiosteal flaps closure are sometimes covered with sterile gauze soaked with soft paraffin or tincture of benzoin or are left open for mucolization by means of secondary intention. The buccal fat pad (BFP) is used as a pedicled graft to cover the exposed bone of the lateral palatal defect, and it is associated with proposed benefits of early healing and fewer effects on transverse growth of the maxilla. Materials and methods This was a prospective study involving 42 cleft palate patients who underwent cleft palate repair; 21 patients received BFP as an additional step to cover lateral palatal defect while the rest of the patients (n=21) underwent conventional surgical cleft palate repair and the defect was covered with Surgicel (Ethicon, Inc., Bridgewater, NJ). Postoperative follow-up was conducted at first, second, and third weeks postoperatively to assess the time required for mucolization. Results Our cohort of 42 patients included an equal number of complete and incomplete cleft palate patients. Follow-up at the first postoperative week showed an equal number (n=21, 100%) patients with incomplete mucolization on both groups, while at the second postoperative follow-up, only one (4.8%) of the patients who underwent conventional cleft palate repair had complete mucolization while 20 (95.2%) among the patients who underwent BFP had complete mucolization. At the third-week postoperative follow-up, three (14.3%) patients from the conventional group had complete mucolization, while 18 (85.7%) had incomplete mucolization. Only two patients (4.8%) developed recipient area complications, and they were managed conservatively. Conclusion BFP is a good source of vascularized tissue to cover the hard palate bones after primary cleft repair. It is easy to harvest as a local tissue with a low learning curve. The epithelialization rate is faster than conventional methods with minimal complication rates.

Background: Palatal fistula is the most common complicationfollowing cleft palate repair. Plenty of reconstructiveprocedures have been described for repair of these fistulas.This study describes a reliable technique of vertical proximallybased turn over gingivolabial myomucosal flap for closure ofanterior palatal fistulas.Methods: Thirty four patients presented with large sizesanterior palatal fistulas underwent closure using verticalproximally based turn over gingivolabial myomucosal flaps.The procedure is a single stage with nasal layer closure whileoral layer left for re epithelialization.Results: All flaps completely survived. Two out of 34flaps (5.8%) suffered distal necrosis which improved afterdebridement and secondary suturing but no other complications.All fistulas were completely healed without any evidenceof recurrence during a mean follow-up period of 18 months.Conclusion: The vertical proximally based turn overgingivolabial myomucosal flap is a simple single stage technique.The flap is a reliable good option for closure of anteriorfistula in presenting age groups without donor site morbidity.It is suited for most anterior located palatal fistulas andmedium sized ones.

Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery. Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair. Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction. Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality. Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.

The aim of the present study is to test the feasibility of modified Z-plasty palatoplasty for cleft palate repair in surgeries and provide a new surgical method. Forty cleft palate patients were selected as participants and divided into 2 groups in random. Twenty patients in the experiment group were treated by modified Z-plasty palatoplasty while the other 20 patients in the control group by double opposing Z-plasty and Sommerlad palatoplasty. By evaluating and observing postoperative velopharyngeal movement, speech intelligibility, nasal leaking, analysis of CSL (Computer Structure Language) and X-ray velopharyngeal lateral radiographs, Modified Z-plasty palatoplasty achieved better results than traditional operation. Satisfactory linguistic effects on incomplete cleft palate can be observed after modified Z-plasty palatoplasty treatment. So this method may be used as a clinical choice.

The most incident and the most persistent complication following cleft palate repair is oronasal fistula.

Objective: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. Design: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. Patients: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. Results: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( P < .001), increasing palatal soft-edge width ( P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. Conclusions: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

Objective To determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States. Design Retrospective cross-sectional study using the Kids' Inpatient Database (KID) from 1997 to 2009. Setting Inpatient. Patients Children with cleft palate with or without cleft lip undergoing inpatient cleft palate repair. Main outcome measures Age at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location. Results A total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months (95% CI 12.0-12.3). Females underwent palatoplasty at an older age (13.6 months) than males (13.2 months), a difference of 0.47 months (SE: 0.19, p=0.015). White children underwent surgery at an earlier age (12.1 months) than Black (12.9 months) (difference: 0.73 months, SE: 0.37, p=0.045), Hispanic (12.7 months) (difference: 0.57 months, SE 0.25, p=0.025), and Asian children (15.7 months) (difference: 3.60 months, SE 0.49, p

Oronasal fistula following cleft palate repair is a considerable complication with a recurrence rate of 33% to 37% and remains a challenging problem for surgeons. Furthermore, many patients have undergone several operations and experienced scar problems and other forms of morbidity. Therefore, we report a multilayered technique for oronasal fistula closure using an endoscopic nasal inferior turbinate composite graft with a palatal advance flap. This will increase the success rate after closure of small-sized oronasal fistula surgery without complications or recurrence (IRB: 2020-1671-0001).

Supplemental Digital Content is available in the text., Background: Whether treatment of cleft palate (CP) associated with Robin sequence (RS) should attain outcomes similar to those of isolated cleft palate (ICP) remains unknown. This study compares treatment and outcomes in both conditions and delineates predictors of long-term outcome. Methods: This retrospective case series of consecutive syndromic and isolated RS- and ICP-patients (1990–2016) includes indications and outcomes of straight-line repair with intravelar veloplasty (SLIV) or Furlow repair depending on cleft and airway characteristics. Results: Seventy-five RS and 83 ICP patients underwent CP repair. Velopharyngeal insufficiency (VPI) occurred in 41% of RS versus 17% of ICP patients (P = 0.012), and in 60% of patients with syndromic RS versus 16% with isolated RS (P = 0.005). In multivariable logistic regression analysis, wider and more severe CP anatomy was the only factor independently associated with VPI (P = 0.028), in contrast to age at repair, syndromic RS compared with isolated RS, and isolated RS compared with ICP and initial tongue-lip adhesion. Secondary Furlow after primary SLIV was used to treat VPI in all groups, and more frequently in syndromic versus isolated RS patients (P = 0.025). Conclusions: Variability of RS anatomy and airway compromise necessitates individualized treatment protocols. Despite differing CP etiology and other variables, our findings demonstrate cleft anatomy as the only independent variable predictive of VPI comparing RS and ICP patients. Patients with isolated RS should ultimately attain similar VPI outcomes compared with ICP patients. Obstructive speech operations in RS patients can be avoided without compromising speech outcome by reserving the prsocedure for secondary cases.

OBJECTIVES/HYPOTHESIS To investigate perceptual speech outcomes following sphincter pharyngoplasty (SP) and to identify patient characteristics associated with velopharyngeal insufficiency (VPI) resolution or improvement. METHODS Retrospective review of prospectively collected data was performed of consecutive patients that underwent SP for management of VPI between 1994 and 2016 at a single tertiary care pediatric hospital. Demographic data, nasendoscopic findings, and speech characteristics were recorded using a standardized protocol. Pre- and post-operative VPI was graded on a five-point Likert scale. Frequency of post-operative VPI resolution and improvement was assessed and associations with patient characteristics were analyzed. The association between odds of VPI resolution or improvement and five patient characteristics identified a priori was performed controlling for confounding factors. RESULTS Two-hundred ninety-six subjects were included. All patients had at least minimal VPI pre-operatively; 72% were graded moderate or severe. Sixty-four percent experienced resolution and 83% improved at least one point on the VPI-severity scale. Of the five patient characteristics, only history of cleft palate repair was significantly associated with decreased odds of VPI improvement but not resolution when controlling for other variables. CONCLUSIONS Sphincter pharyngoplasty resulted in resolution of VPI in 64% and improvement in 83% of subjects. Children with a history of cleft palate had significantly decreased odds of VPI improvement compared to those without a history of cleft palate. Neither syndrome diagnosis nor 22q11 deletion had a significant association with speech outcomes after sphincter pharyngoplasty. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2046-E2052, 2021.

Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.

Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to perform cleft surgeries.The Aga Khan University medical records database was queried for pediatric patients undergoing cleft surgery between 2014 and 2017. Data were abstracted from the patient medical records, and details of the clinical, demographic factors, and postoperative outcomes were assessed.Among 142 patients with orofacial clefts, 102 (72%) underwent primary cleft palate repair, one-third (n = 36, 35%) of whom were operated as part of the Smile Train. The median preoperative hemoglobin was 11.4 g/dL (interquartile range: 10.7-12.0 g/dL), whereas the median weight was 8.3 kg (7.7-11.4 kg). Nearly two-thirds (n = 64, 63%) of the cohort underwent preoperative cardiology screening, with only a minority undergoing orthodontic treatment (n = 6, 6%). Approximately 15% (n = 15) of patients experienced a postoperative complication, most often a fistula (n = 11, 73%). On multivariable analysis, with each unit increase in hemoglobin levels, there was a 50% reduction in the odds of experiencing a complication (odds ratio: 0.51, 95% CI: 0.28-0.87). There were no in-patient deaths among the cohort.The results of the current study provide useful information to key stakeholders including patients, plastic surgeons, and policy makers on the outcomes of cleft palate repair in a developing country.La réparation des fentes palatines est considérée comme une intervention sécuritaire, mais comporte un risque de complications de 5 % à 30 %. La présente étude vise à évaluer les résultats de cette intervention dans un pays asiatique au fardeau élevé où les partenaires de Smile Train corrigent des fentes palatines.Les chercheurs ont fouillé la base de données des dossiers de l’université Aga Khan pour en extraire les patients pédiatriques qui ont subi une intervention de fente palatine entre 2014 et 2017. Ils ont résumé les données des dossiers médicaux des patients et évalué le détail des facteurs cliniques et démographiques ainsi que les résultats postopératoires.Sur les 142 patients ayant une fente labiopalatine, 102 (72 %) ont subi une réparation palatine primaire, dont le tiers a été opéré (n = 36, 35 %) par l’équipe de Smile Train. L’hémoglobine préopératoire médiane était de 11,4 g/dl (ratio interquartile de 10,7 à 12,0 g/dl), et le poids médian, de 8,3 kg (7,7 g à 11,4 kg). Près des deux tiers des membres de la cohorte (n = 64, 63 %) ont subi un dépistage préopératoire, et seule une minorité a suivi un traitement orthodontique (n = 6, 6 %). Environ 15 % des patients (n = 15) ont souffert d’une complication postopératoire, la plupart du temps sous forme de fistule (n = 11, 73 %). À l’analyse multivariée, à chaque nouvelle unité d’hémoglobine, le risque de complication diminuait de 50 % (rapport de cotes 0,51, IC à 95 %, 0,28 à 0,87). Aucun patient hospitalisé n’est décédé au sein de la cohorte.Les résultats de la présente étude fournissent de l’information utile aux principaux intervenants, y compris les patients, les plasticiens et les décideurs, sur les résultats des réparations de la fente palatine dans un pays industrialisé.

Background Improving surgeons' technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial. Methods A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention. Results Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4 percent (range, 0 to 10.5 percent). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9 percent at baseline and 0.0 percent following feedback (adjusted OR, 0.98; 95 percent CI, 0.44 to 2.17). Conclusion Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons.

The aim of the study was to determine the efficacy and safety of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children with congenital malformation, cleft palate. The study was carried out on 55 patients with primary cleft palate repair. The average age of the patients was 1 year 8 months6 months. Patients were divided into 2 groups. In the main group, general anesthesia, local anesthesia and bilateral suprazygomatic maxillary nerve block were performed. In the control group, general anesthesia and local anesthesia were performed. The severity of the pain syndrome in children was assessed according to the FLACC scale. In addition, the dose opioid analgesics (tramadol) was taken into account on the 1st day; satisfaction with anesthesia and analgesia. Results for the main group: FLACC indicators were kept longer at a low level; less consumption of opioid analgesics. No complications were observed on the bilateral suprazygomatic maxillary nerve block. The bilateral suprazygomatic maxillary nerve block for primary cleft palate repair in children provides a better quality of anesthesia, and, especially postoperative analgesia.

Introduction: Materials used for posterior pharyngeal wall augmentation have been associated with important complications (exogenous materials) or variable and unpredictable durability (exogenous and endogenous materials); therefore, introducing a different material for augmenting the posterior pharyngeal wall seems necessary for reviving this relatively forgotten technique.The purpose of this study was to emphasize on the use of a material associated with minimal complications and maximum recovery and durability in correcting VPI and the use of evaluative adjuncts such as nasoendoscopy and videofluoroscopy to assess surgical outcomes. Methods: In a pilot study, 24 patients underwent posterior pharyngeal wall augmentation with dermal fat graft harvested from the low crease abdominal region. Early and late complications, autologous graft durability in posterior pharynx, and speech improvement were assessed. Results: There was a significant improvement in hypernasality, nasal emission, and nasal grimace after posterior pharyngeal wall augmentation with dermal fat graft (p

Background and objective: The presence of a cleft palate introduces feeding difficulties, problems in speech development, and the possibility of impaired facial growth. Intravelar veloplasty aids to gain functional repair of the palate. This study aimed to evaluate the effect of intravelar veloplasty on the function of velum in primarily repaired palates. Methods: A review study was done in Rizgary Teaching Hospital, Erbil. Clinical and nasopharyngeal endoscopic examination was done for patients who underwent primary palatal repair with intravelar veloplasty between 2009 to 2014. The study assessed the velopharyngeal port for adequacy of closure, hypernasality of speech, and oronasal fistula rate. Results: This study included 47 patients. The mean age of patients ± SD was 3.4±4 years (range 1- 20 years) at time of repair. Major improvement in intelligibility and production of pharyngeal sounds and velopharyngeal closure was noticed when using intravelar veloplasty in palatal repair. There was a significant association between defect type and degree of velopharyngeal port closure (P = 0.009), i.e., inadequate velopharyngeal closure was more common in the complete cleft palate. Conclusion: This study showed that intravelar veloplasty helps to improve the velopharyngeal closure and oropharyngeal sounds production. The poor velopharyngeal closure is more likely related to wide, complete cleft palate. Keywords: Cleft palate; Palatoplasty; Intravelar veloplasty; Velopharyngeal insufficiency.

OBJECTIVES To analyze the pattern of cleft lip and cleft palate cases and their operative management at a tertiary-care hospital. METHODS Data of all patients (

Good speech is the ultimate aim in palate repair. Muscle function has to be optimum for the palate to be able to move to provide this goal. The fact that there has been a multitude of techniques of palatal repair indicates that none has been able to attain the intended objective. The method of intravelar veloplasty as a funtional technique has been the one that has gained wide acceptance all over the world. Use of magnification loops and microscope and better understanding of the cleft anatomy has helped to further refine the technique. This review aims at evaluating the outcome of this technique and its various modifications and complications. Literature search was performed in PubMed, Embase and Lilacs Bireme using the terms 'intravelar veloplasty', 'cleft palate repair', and radical muscle dissection'. No restriction were placed with regards to date of publication or language. Abstracts of the articles were assessed and the selected articles were reviewed in full by the authors. There is a striking diversity in the extent of muscle dissection between cleft surgeons. The evidence from the studies available showed better speech outcomes and velopharyngeal competence with radical intravelar veloplasty with varying complication rates. Uniformity in defining the degree of dissection of muscle by using a classification and standardised methods of outcome measurements are to be used in future studies to provide high quality evidence to guide decisions.

BACKGROUND: Improving surgeons’ technical performance may reduce their frequency of post-operative complications. We conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial. METHODS: A non-randomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention. RESULTS: Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4% (range, 0%–10.5%). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9% at baseline and 0.0% following feedback (adjusted odds ratio, 0.98; 95% CI, 0.44–2.17). CONCLUSIONS: Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02583100

Objectives: Despite improved techniques in repair of cleft palate, failure of healing of palatal structures resulting in a palatal fistula is one of the major challenges in the practice of reconstructive surgery. The aim of this study is to evaluate treatment success and failure in patients with palatal fistulas following cleft palate repair. Patients and Methods: Totally 44 patients with a history of cleft palate who underwent surgery for palatal fistula were included in this study undertaken between January 1999 and August 2014. Fistulas were classified as anterior and posterior according to the repair technique and were repaired using one of the following techniques: buccal mucosal flap, tongue flap or mucoperiosteal flap. Results: Success rate for anterior fistulas was 71.42% with tongue flap and 76.92% with mucoperiosteal flap. Success rate for posterior fistulas was 84.62% with mucoperiosteal flap and 75% with buccal mucosal flap. Difference in success rates between the anterior and posterior fistulas was not statistically significant. Conclusion: Our study results suggest the use of mucoperiosteal flaps for both anterior and posterior fistulas smaller than 5mm as the first choice, guided by the principle of replacing absent tissue with similar tissue.

STUDY OBJECTIVES: In view of the risk that surgical repair of cleft palate may induce or worsen obstructive sleep apnea (OSA), the goal of this study was to assess presurgical and postsurgical polysomnography (PSG) results for children who underwent primary palatoplasty. METHODS: Retrospective case-control series for children with cleft palate repair performed between January 2008 and December 2016 at a tertiary pediatric center. Children underwent PSG before and after surgery. RESULTS: Sixty-four children (53.1% female) with a mean age of 2.0 ± 2.8 years (range 0.6–16.4) were included in the study. Pierre-Robin sequence was the most common comorbidity (67%). Before palatal repair, the mean obstructive apnea-hypopnea index (oAHI) was 3.4 ± 3.9 (range 0–17.9) events/h; this did not significantly change, with 5.9 ± 14.5 (range 0–105.7) events/h after surgery (P = 0.30). However, 34.4% of patients had a worsening of more than 1 obstructive event/h and 18.9% had a worsening of 5 or more obstructive events/h. The presence of a concomitant syndrome (eg, Treacher Collins) was a risk factor for postoperative OSA (odds ratio 4.2, 95% confidence interval 1.1–15.8, P = .03) CONCLUSIONS: OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA. CITATION: Bergeron M, Cohen AP, Maby A, Babiker HE, Pan BS, Ishman SL. The effect of cleft palate repair on polysomnography results. J Clin Sleep Med. 2019;15(11):1581–1586.

Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function. Design: A retrospective cohort study. Setting: A regional specialist cleft lip and palate center within United Kingdom. Patients, Participants: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria. Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release. Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age. Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; P < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%). Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.