Background:A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques.Methods:A systematic search of the English literature published in the MEDLINE, O

A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair.

The presence of a palatal cleft at birth should not prevent good speech production in most children provided they have (1) appropriate surgical intervention to close the palate at or around the child's first birthday, (2) careful monitoring of speech development throughout childhood, (3) speech therapy when needed, and (4) secondary surgical or speech-prosthetic intervention when needed. When managed carefully by an experienced, well-prepared multidisciplinary team that applies the criteria listed above, ~70% of children with nonsyndromic palatal clefts will have no significant difficulties with speech intelligibility or speech quality due to velopharyngeal insufficiency by the time they enter elementary school. Speech assessment is the first step toward comprehensive team management of children with cleft palate. The purpose of this chapter is to describe the use of instrumentation in the evaluation of speech of children with palatal clefts, within the context of a multidisciplinary team. The focus of this article is on instruments that are used to supplement the perceptual assessment to document current speech status and plan management strategies.

Instrumental assessment of velopharyngeal closure for speech.

Background The aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair. Patients and methods Patients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria. Results A total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively). Conclusion The similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate.

Objective:To investigate the age effects of cleft palate repair on middle ear function and hearing level in patients who underwent cleft palate repair at different ages by audiologic examination.Me...

https://journals.sagepub.com/doi/pdf/10.1177/1055665618754632

The Effects of Age at Cleft Palate Repair on Middle Ear Function and Hearing Level.

Purpose The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. Methods Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological – audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. Results There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. Conclusion Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.

The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate

SUMMARY Introduction The importance of the soft palate is greater than its dimension. Velopharyngeal muscles have diverse functions. The goal of this study was to clarify the efficacy of levator-palatopharyngeus surgery according to Kriens. Material and methods Retrospective follow-up of 22 cleft patients operated at the Department of Oral and Maxillo-Facial and Plastic Surgery at the University of Greifswald between 1994 to 2001, within the context of primary closure of the palate. A questionnaire evaluated parents' opinion of postoperative results of treatment. Speech, videoendoscopics and hearing findings were analyzed. Results Parents assessed success of the treatment as adequate to very good. More than a half of the patients had perfect or very usable colloquial speech. Speech findings of patients with palatal clefts (CP) were significantly better than those of patients with clefts of lip, alveolus and palate (CLAP) (p = 0.043). Velopharyngeal closure pattern with highest prevalence was the coronal closure type. Subjects with CLAP were much more likely to have poor velopharyngeal closure (VPI > 2 mm2; 58%) than those with a CP (12%). More than 75% of the patients showed normal hearing results in the audiogram. Conclusion Levator-palatopharyngeus surgery according to Kriens seems to be effective in exact reconstruction of velar muscle sling, improving velopharyngeal structure and function.

Videoendoscopic, speech and hearing in cleft palate children after levator-palatopharyngeus surgery according to Kriens

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Videoendoscopic, speech and hearing in cleft palate children after levator-palatopharyngeus surgery according to Kriens