Cleft palate, treatment and complications
Abstract
Introduction: The purpose of this study is to determine the incidence of velopharyngeal insufficiency (VPI), fistulae and recurrence development in patients seen by the Isfahan Cleft Care Clinic and also determine the association of gender, age at repair, and cleft type with the incidence of each. Materials and Methods: In this retrospective study, 320 children who had undergone a primary cleft palate surgery and who had come to the cleft lip and palate clinic in Isfahan in 2010-2017 were studied based on the medical records and information about each patient. Then all patients were evaluated by standard speech assessment methods for severity of hypernasalitis and screened for clinical manifestations of fistula and recurrence. Results: According to the results of this study, the incidence of velopharyngeal insufficiency after initial repair was 78.1% and most of these patients had severe form. The results also showed that by increasing age at surgery also increased the intensity of velopharyngeal insufficiency, and the severity of this complication has nothing to do with gender. In the case of fistula and recurrence of cleft showed that, in patients who are undergoing the new procedure to be significantly less than other patients. Conclusion: According to the study, palatoplasty complications such as velopharyngeal insufficiency, fistula, and recurrence were less common in patients treated with microsurgery, Therefore, it can be concluded surgical repair of cleft palate should be performed before 12 months ages and in microsurgery methods. It seems that follow up of these patients after surgery for monitoring of speech complications is necessary. Keywords: Cleft palate; Velopharyngeal insufficiency; Fistula; Palatoplasty; Microsurgery.
1. Brunicardi C AD, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartzs Principes of surgery. United States of America: McGraw-Hill Education; 2015.
2. Kummer AW, Clark SL, Redle EE, Thomsen LL, Billmire DAJTCP-CJ. Current practice in assessing and reporting speech outcomes of cleft palate and velopharyngeal surgery: a survey of cleft palate/craniofacial professionals. 2012;49(2):146-52.
3. Yuan N, Dorafshar AH, Follmar KE, Pendleton C, Ferguson K, Redett III RJJAops. Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. 2016;76(4):406-10.
4. Kummer A. Cleft palate and craniofacial anomalies: effects on speech and resonance USA: Thomson Delmar Learning. Inc; 2011.
5. Owusu JA, Liu M, Sidman JD, Scott ARJTL. Does the type of cleft palate contribute to the need for secondary surgery? A national perspective. 2013;123(10):2387-91.
6. Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP. Cleft palate speech: Mosby St. Louis, MO; 2001.
7. Howard S, Lohmander A. Cleft palate speech: assessment and intervention: Wiley Online Library; 2011.
8. Amirian AJCPCJ. Developing of" Cleft palate speech assessment test based on universal parameters system-in persian". Master science thesis in medical university of Isfahan; 1389.[Article in persian] 19-Henningsson G, Kuehn D, Sell D, Sweeney T, Trost-cardamone JE, Whitehill T, speech parameters Group. Universal parameters for reporting speech outcomes in individuals with cleft palate. 2008;45:1-17.
9. Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill TLJTCP-CJ. Universal parameters for reporting speech outcomes in individuals with cleft palate. 2008;45(1):1-17.
10. Pradubwong S, Mongkholthawornchai S, Keawkhamsean N, Patjanasoontorn N, Chowchuen BJJMAT. Clinical outcomes of primary palatoplasty in preschool-aged cleft palate children in Srinagarind hospital: quality of life. 2014;97(Suppl 10):S25-31.
11. Phua YS, de Chalain TJTcp-cJ. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. 2008;45(2):172-8.
12. Rullo R, Di Maggio D, Festa V, Mazzarella NJIjopo. Speech assessment in cleft palate patients: a descriptive study. 2009;73(5):641-4.
13. Persson C, Lohmander A, Elander AJTCp-cj. Speech in children with an isolated cleft palate: a longitudinal perspective. 2006;43(3):295-309.
14. Brunnegård K, Lohmander AJTCp-cj. A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability. 2007;44(1):33-44.
15. Snell RS. Clinical anatomy by regions: Lippincott Williams & Wilkins; 2011.
16. Murthy J, Sendhilnathan S, Hussain SAJTcp-cj. Speech outcome following late primary palate repair. 2010;47(2):156-61.
17. Abdel-Aziz MJIjopo. Speech outcome after early repair of cleft soft palate using Furlow technique. 2013;77(1):85-8.
18. Chapman KL, Hardin-Jones MA, Goldstein JA, Halter KA, Havlik RJ, Schulte JJTCP-CJ. Timing of palatal surgery and speech outcome. 2008;45(3):297-308.
19. Hosseinabad HH, Derakhshandeh F, Mostaajeran F, Abdali H, Davari HA, Hassanzadeh A, et al. Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: A retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009. 2015;79(10):1722-6.
20. Schuster T, Rustemeyer J, Bremerich A, Günther L, Schwenzer-Zimmerer KJJoC-MS. Analysis of patients with a cleft of the soft palate with special consideration to the problem of velopharyngeal insufficiency. 2013;41(3):245-8.
21. Chen Q, Zheng Q, Shi B, Yin H, Meng T, Zheng G-nJJorimstojoIUoMS. Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients. 2011;16(7):945.
22. Yang Y, Li Y, Wu Y, Gu Y, Yin H, Long H, et al. Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. 2013;24(3):923-8.
23. Sadler TW. Langman's medical embryology: Lippincott Williams & Wilkins; 2011.
24. Ysunza A, Pamplona MC, Morales MSJIjopo. Velopharyngeal valving during speech, in patients with velocardiofacial syndrome and patients with non-syndromic palatal clefts after surgical and speech pathology management. 2011;75(10):1255-9.
25. Zhao S, Xu Y, Yin H, Zheng Q, Wang Y, Zhong T, et al. Incidence of postoperative velopharyngeal insufficiency in late palate repair. 2012;23(6):1602-6.
2. Kummer AW, Clark SL, Redle EE, Thomsen LL, Billmire DAJTCP-CJ. Current practice in assessing and reporting speech outcomes of cleft palate and velopharyngeal surgery: a survey of cleft palate/craniofacial professionals. 2012;49(2):146-52.
3. Yuan N, Dorafshar AH, Follmar KE, Pendleton C, Ferguson K, Redett III RJJAops. Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. 2016;76(4):406-10.
4. Kummer A. Cleft palate and craniofacial anomalies: effects on speech and resonance USA: Thomson Delmar Learning. Inc; 2011.
5. Owusu JA, Liu M, Sidman JD, Scott ARJTL. Does the type of cleft palate contribute to the need for secondary surgery? A national perspective. 2013;123(10):2387-91.
6. Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP. Cleft palate speech: Mosby St. Louis, MO; 2001.
7. Howard S, Lohmander A. Cleft palate speech: assessment and intervention: Wiley Online Library; 2011.
8. Amirian AJCPCJ. Developing of" Cleft palate speech assessment test based on universal parameters system-in persian". Master science thesis in medical university of Isfahan; 1389.[Article in persian] 19-Henningsson G, Kuehn D, Sell D, Sweeney T, Trost-cardamone JE, Whitehill T, speech parameters Group. Universal parameters for reporting speech outcomes in individuals with cleft palate. 2008;45:1-17.
9. Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill TLJTCP-CJ. Universal parameters for reporting speech outcomes in individuals with cleft palate. 2008;45(1):1-17.
10. Pradubwong S, Mongkholthawornchai S, Keawkhamsean N, Patjanasoontorn N, Chowchuen BJJMAT. Clinical outcomes of primary palatoplasty in preschool-aged cleft palate children in Srinagarind hospital: quality of life. 2014;97(Suppl 10):S25-31.
11. Phua YS, de Chalain TJTcp-cJ. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. 2008;45(2):172-8.
12. Rullo R, Di Maggio D, Festa V, Mazzarella NJIjopo. Speech assessment in cleft palate patients: a descriptive study. 2009;73(5):641-4.
13. Persson C, Lohmander A, Elander AJTCp-cj. Speech in children with an isolated cleft palate: a longitudinal perspective. 2006;43(3):295-309.
14. Brunnegård K, Lohmander AJTCp-cj. A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability. 2007;44(1):33-44.
15. Snell RS. Clinical anatomy by regions: Lippincott Williams & Wilkins; 2011.
16. Murthy J, Sendhilnathan S, Hussain SAJTcp-cj. Speech outcome following late primary palate repair. 2010;47(2):156-61.
17. Abdel-Aziz MJIjopo. Speech outcome after early repair of cleft soft palate using Furlow technique. 2013;77(1):85-8.
18. Chapman KL, Hardin-Jones MA, Goldstein JA, Halter KA, Havlik RJ, Schulte JJTCP-CJ. Timing of palatal surgery and speech outcome. 2008;45(3):297-308.
19. Hosseinabad HH, Derakhshandeh F, Mostaajeran F, Abdali H, Davari HA, Hassanzadeh A, et al. Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: A retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009. 2015;79(10):1722-6.
20. Schuster T, Rustemeyer J, Bremerich A, Günther L, Schwenzer-Zimmerer KJJoC-MS. Analysis of patients with a cleft of the soft palate with special consideration to the problem of velopharyngeal insufficiency. 2013;41(3):245-8.
21. Chen Q, Zheng Q, Shi B, Yin H, Meng T, Zheng G-nJJorimstojoIUoMS. Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients. 2011;16(7):945.
22. Yang Y, Li Y, Wu Y, Gu Y, Yin H, Long H, et al. Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. 2013;24(3):923-8.
23. Sadler TW. Langman's medical embryology: Lippincott Williams & Wilkins; 2011.
24. Ysunza A, Pamplona MC, Morales MSJIjopo. Velopharyngeal valving during speech, in patients with velocardiofacial syndrome and patients with non-syndromic palatal clefts after surgical and speech pathology management. 2011;75(10):1255-9.
25. Zhao S, Xu Y, Yin H, Zheng Q, Wang Y, Zhong T, et al. Incidence of postoperative velopharyngeal insufficiency in late palate repair. 2012;23(6):1602-6.
| Files | ||
| Issue | Vol 7, No 1 (Winter 2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v7i1.4006 | |
| Keywords | ||
| Cleft palate; Velopharyngeal insufficiency; Fistula; Palatoplasty; Microsurgery. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Davari HA, Jafari M, Zandi Esfahani H. Cleft palate, treatment and complications. J Craniomaxillofac Res. 2020;7(1):5-12.
