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Effects of Cleft Width and Veau Type on Incidence of Palatal Fistula and Velopharyngeal Insufficiency After Cleft Palate Repair

Yuan, Nance MD; Dorafshar, Amir H. MBChB; Follmar, Keith E. MD; Pendleton, Courtney MD; Ferguson, Katherine CCC-SLP; Redett, Richard J. III MD

doi: 10.1097/SAP.0000000000000407
Head and Neck Surgery

Background Postoperative fistulae and velopharyngeal insufficiency (VPI) are 2 important complications after cleft palate repair. The effects of preoperative cleft width on outcomes after cleft palate repair have been rarely studied.

Methods A retrospective review of all patients undergoing primary cleft palatoplasty by a single surgeon between 2004 and 2011 was performed. Primary outcomes were palatal fistula and VPI, defined as the need for corrective surgery after failing conservative speech-language therapy. Logistic regression analysis was performed to identify factors associated with the primary outcomes.

Results One hundred seventy-seven patients (84 men and 93 women) were identified. Median age at repair was 10 months with median follow-up of 3.80 years. Preoperative cleft width was 10 mm or less for 72 (41%) patients, 11 to 14 mm for 54 (30%) patients, and 15 mm or greater for 51 (29%) patients. Palatal fistula was observed in 8 (4.5%) patients, but required surgical repair in only 2 (1.1%). Fistula was overall associated with Veau IV classification (odds ratio, 8.13; P < 0.01) but not with cleft width. Velopharyngeal insufficiency needing surgical intervention occurred in 9 patients (7.38% of patients older than 4 years) and was associated with increasing cleft width (odds ratio, 1.29; P = 0.011). Outcomes were similar for patients undergoing surgery in the earlier and later halves of the study.

Conclusions This retrospective review is one of the first from the United States to explore the associations between measured cleft width and outcomes after palatoplasty. Overall rates of palatal fistula and VPI were low, corroborating previous studies showing good outcomes with the 2-flap palatoplasty. After adjusting for multiple variables including Veau type, cleft width was associated with higher VPI rates but not with fistula formation. Cleft width is a unique preoperative factor that should be considered and studied as a potential predictor of outcomes.

From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.

Received May 12, 2014, and accepted for publication, after revision, October 31, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Richard J. Redett, III, MD, Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institutions, 1800 Orleans St, Bloomberg 7314B, Baltimore, MD. E-mail:

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