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The importance of radical intravelar veloplasty during two-flap palatoplasty
- Source :
- Plastic and reconstructive surgery. 122(4)
- Publication Year :
- 2008
-
Abstract
- The purpose of this study was to compare the two-flap palatoplasty technique for cleft palate repair, with and without radical intravelar veloplasty, with special emphasis on the fistula rate and speech outcome.A retrospective, time-series cohort of 213 consecutive patients with primary two-flap palatoplasty before and after the introduction of a radical intravelar veloplasty was studied. The main outcome measures were immediate postoperative complications, oronasal fistula rate, and speech. A perceptual speech evaluation was performed by two speech pathologists and included hypernasality, nasal emission, articulation, intelligibility, and overall velopharyngeal competence. The need for secondary palate surgery for velopharyngeal insufficiency was also analyzed.There were no differences in postoperative complications between the two study groups. Postoperative morbidity occurred in six patients (2.8 percent) and consisted of two patients with respiratory compromise, two patients who required reoperation for bleeding, and two patients with oronasal fistula. Perceptual speech evaluation demonstrated significantly better speech outcomes (81.9 percent versus 49.5 percent, p0.001) and a significantly lower rate of secondary palate surgery for velopharyngeal insufficiency (29 percent versus 6.7 percent, p = 0.008) in the radical intravelar veloplasty group. The most important predictive factor of speech outcome was the addition of a radical intravelar veloplasty (odds ratio, 0.175; 95 percent confidence interval, 0.039 to 0.785).Despite study design limitations, such as experience bias and follow-up differences, this study demonstrates that radical intravelar veloplasty may enhance the functional results of the two-flap palatoplasty without increasing postoperative morbidity. A novel classification of the muscle repair is proposed based on the amount of muscle dissection and retropositioning.
- Subjects :
- Male
medicine.medical_specialty
Velopharyngeal Insufficiency
business.industry
Fistula
medicine.medical_treatment
Infant
Retrospective cohort study
Plastic Surgery Procedures
medicine.disease
Surgical Flaps
Surgery
Cleft Palate
Palatoplasty
Velopharyngeal insufficiency
Cleft palate repair
Cohort
medicine
Humans
Female
business
Cleft palate surgery
Retrospective Studies
Subjects
Details
- ISSN :
- 15294242
- Volume :
- 122
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Plastic and reconstructive surgery
- Accession number :
- edsair.doi.dedup.....68fce4e8c5595e6946aa38814dc980a2