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Objectives: In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome. Materials and methods: A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model. Results: One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15–24), after Z-palatoplasty 6% (95% CI 4–9), and after palatoplasty with buccal flaps 7% (95% CI 4–11). Conclusions: A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair. Clinical relevance: Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality. [ABSTRACT FROM AUTHOR]

Introduction: To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function. Materials and Methods: A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the "Golding-Kushner" scale for NPS results was used for assessing the patient's velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson's Chi-square analysis and binary logistic regression were used for statistical analysis. Results: A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow's technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by "two flap" only in 48.1% and von Langenbeck in 47.1% of cases. Discussion: The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty. [ABSTRACT FROM AUTHOR]

Cleft palate causes loss of every function of the face except vision. A child born with cleft palate with or without cleft lip should not be considered unfortunate, because cleft palate surgical repair has reached a highly satisfactory level.A large number of techniques are available in literature to treat cleft palate patients, and also every surgeon incorporates his own modification to make it a variation. Understanding of material usage in palatoplasty is important to bring about variation and successful treatment options. The aim of this study is to assess the role of surgicel and buccal pad of fat in cleft palate surgical procedures. This is a university setting study. Data of cleft palate patients who reported to Saveetha Dental College and Hospital between June 2019 to March 2020 were reviewed. The case sheets of these patients were evaluated to see if placement of surgicel or buccal pad of fat was done in primary palatoplasty. The data was then entered in SPSS and analysed using Chi square test. It was observed that buccal pad of fat(77%) was the commonly used material for cleft palate procedures. Within the limitations of this study, it can be concluded that the adjunct material of choice for cleft surgeons of saveetha dental hospital during surgical repair of cleft palate is buccal pad of fat which may be due to its healing efficacy, no material costs involved, also can be used for both genders in all age groups, and we can avoid forign body material especially in small children. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of ketorolac on opiate requirement and hospital length of stay after palatoplasty., Design: This was a retrospective chart review., Setting: This study was completed at an urban tertiary medical center., Patients: Those who underwent palatoplasty with a pediatric otolaryngologist between 2010-2020., Interventions: Incorporation of standing Ketorolac into the immediate post-operative pain regimen., Main Outcome Measures: T-test analysis was performed to determine whether initiation of ketorolac within 24 h post-palatoplasty was correlated with shorter length hospitalization or reduced opiate requirement., Results: A total of 55 pediatric subjects (49.1% female) were included in this study. Average age at time of surgery was 13 months (range 9.9-33.9 months). On two tailed t-test, use of ketorolac within the first 24 h after palatoplasty was associated with shorter length of stay (mean of 1.68 vs 2.57 days, t = 2.58, P  = .01) and lower total opiate dosage during hospitalization (mean of 2.8 vs 9.16 morphine milligram equivalents, t = 3.37, P  = .001)., Conclusions: Among patients undergoing palatoplasty, there is a significant relationship between the early utilization of ketorolac and decreased length of hospitalization as well as decreased opiate requirement. This has important consequences to help improve pain control with reduced opiates requirement as well as length of stay. Future prospective studies can help elicit the causative effect of Ketorolac on these parameters and can investigate whether use of Ketorolac has an effect on long term recovery and post-discharge opiate requirements as well., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background:Few studies have been published reporting risk factors for flap necrosis after primary palatoplasty in patients with cleft palate. This complication is rare, and the event is a disaster for both the patient and the surgeon. This study was performed to explore the associations between different risk factors and the development of flap necrosis after primary palatoplasty in patients with cleft palate. Methods:This is a case-control study. A 20 years retrospective analysis (1994–2015) of patients with nonsyndromic cleft palate was identified from medical records and screening day registries). Demographical and risk factor data were collected using a patient´s report, including information about age at surgery, gender, cleft palate type, and degree of severity. Odds ratios and 95% confident intervals were derived from logistic regression analysis. Results:All cases with diagnoses of flap necrosis after primary palatoplasty were included in the study (48 patients) and 156 controls were considered. In multivariate analysis, female sex, age (older than 15 years), cleft type (bilateral and incomplete), and severe cleft palate index were associated with significantly increased risk for flap necrosis. Conclusions:The findings suggest that female sex, older age, cleft type (bilateral and incomplete), and severe cleft palatal index may be associated with the development of flap necrosis after primary palatoplasty in patients with cleft palate. [ABSTRACT FROM AUTHOR]

The purpose of this study is to compare the results of the surgical treatment of cleft palate obtained using 2 different protocols. We conduct a retrospective study comparing a protocol A, using one surgical technique to address all cleft types, and a protocol B, using different surgical techniques according to our proposed classification, and determining the number of fistulas and velopharyngeal insufficiency obtained using each protocol. We have seen statistically significant differences in the number of palatal fistulas between the two protocols, on behalf of protocol B (p: 0.0001). We have not seen statistically significant differences in the number of velopharyngeal insufficiency cases between the two protocols (p: 0.64) In summary, we observed less number of fistulas using the individualized protocol (protocol B) in the surgical treatment of cleft palates showing the efficacy of the proposed classification and used techniques. These conclusions support our proposal in this article with the new classification and individualized surgical protocol. [ABSTRACT FROM AUTHOR]

Objective: To introduce a surgical technique for the repair of cleft palate with the single and full-thickness Z-plasty method. Patients and Methods: The procedure was performed from 1999 to 2006 in 34 patients with cleft palate with a median age of 6.0 years (range, 2.0 to 21 years). In these patients, in order to push the soft palate back farther, a single and full-thickness Z-plasty, designed on the soft palate across the defect, was applied to the von Langenbeck procedure. The full thickness of the soft palate was incised after the hard palate was closed by suturing the two mucoperiosteal flaps, and two Z-plasty flaps were formed. The two flaps were then transposed and closed by interrupted suturing of three layers of the palate in proper order, from nasal mucosa, levator muscle to oral mucosa. The patients were followed for 6 months to 3 years, velopharyngeal closure was examined by nasopharyngeal fiberscope and/or x-ray radiography, and a clinical speech evaluation was performed. Results: In all patients, no problem of flap viability was encountered and all healed well. The postoperative results were satisfactory without any complications such as dehiscence, perforation, or palatal fistula. The clinical speech evaluation was satisfactory, and the effects of the operation were stable. Conclusions: The technique presented has been effective, having the advantages of palatal closure without tension and with sufficient lengthening of the soft palate. [ABSTRACT FROM AUTHOR]

Summary: During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed. [Copyright &y& Elsevier]

Background: Cleft lip with or without cleft palate is one of the most common birth defects and is certainly the most visible. Fistula rate after primary palatoplasty was ranging between 10 and 23% and could be detected in the first three weeks after surgery. The cleft width is the frequent factor which was assumed to correspond to fistula occurrence. This study aimed to find correlation between fistula occurrence with cleft width and palatum width ratio after primary palate repair., Methods: A prospective cohort study was conducted on 16 subjects, which consisted of 10 males and 6 females. We measured width of cleft palate, width of rest palate and width of palate arch on three level measurements (posterior, junction and anterior). The surgery was performed using the two-flap and three layers suturing technique., Results: Sixteen patients were enrolled in this study during January and February 2008 . Ten patients were diagnosed with unilateral cleft palate while six patients had bilateral cleft palate. Mean of age was 22.31 ± 5.86 month. Correlation analysis between fistula occurrence and cleft width, cleft width-remnant palate width ratio and cleft width-palate arch width ratio using logistic regression did not show statistical correlation, and the same result was found between fistula occurrence and hemoglobin level, white blood count, nutritional status, cleft type and caries dentis factors ( p  > 0.05)., Conclusion: Width of the cleft is not a factor associated with fistula occurrence. Two-flap three layers technique could be considered as a simple technique and gives a low rate of fistula occurrence., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)