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Adult Quality of Life Post Cleft Palate Repair

A Comparison of Two Techniques

Skladman, Rachel BA*; Grames, Lynn Marty MA, CCC-SLP; Skolnick, Gary BS*; Nguyen, Dennis C. MD, MS*; Naidoo, Sybill D. PhD, CPNP*; Patel, Kamlesh B. MD*; Marsh, Jeffrey L. MD; Woo, Albert S. MD§

Journal of Craniofacial Surgery: June 2017 - Volume 28 - Issue 4 - p 909–914
doi: 10.1097/SCS.0000000000003526
Original Articles

Background and Purpose: In 1989, the Cleft Palate-Craniofacial Journal published the first randomized prospective cleft surgery study, comparing the Kriens intravelar veloplasty (IVV) with a non-IVV 2-flap repair. Results in that and follow-up publications yielded no difference between the 2 groups for need for secondary velopharyngeal management. The subjects have now reached adulthood. This study was designed to ask: Is there any difference between the groups in the outcomes that multidisciplinary team care addresses: speech intelligibility, facial growth, breathing while awake and asleep, attainment of education, and long-term socioeconomic status?

Methods: Enrollees from the original published study were invited to participate in a survey. Subjects responded to questions about speech therapy and speech satisfaction, additional surgery, breathing patterns, sleep quality/sleep disorder, and dental occlusion. Demographic information, information on education level, profession, and socio-economic status were queried. Student t test and Fisher exact test were used to compare results.

Results: Forty-two of the original 200 patients (20 Kriens IVV and 19 non-IVV) chose to participate. Average age at survey was 25 ± 3 years. Analysis yielded no difference between the 2 respondent groups for need for secondary velopharyngeal management. There were no differences in speech outcome and satisfaction (8 questions, 0.30 < P < 0.97), sleep concerns (3 questions, 0.16 < P < 0.39), and dental occlusion (P = 0.69). Equivalent proportions of the 2 groups had been in speech therapy (P = 0.22). There was no difference in education attainment of the 2 groups (P = 0.26).

Conclusions: The original randomized prospective trial suggested that there was no difference between the 2 surgery types in need for secondary velopharyngeal management. This long-term survey study on the same group of patients suggests that in young adulthood, the 2 groups have similar outcomes in terms of education, career choice, speech satisfaction, dental occlusion, and sleep disorder.

*Washington University School of Medicine in St Louis

St Louis Children's Hospital

Kids Plastic Surgery, St Louis, MO

§Alpert School of Medicine, Brown University, Providence, RI.

Address correspondence and reprint requests to Rachel Skladman, BA, 1669 Braeside Lane, Northbrook, IL 60062; E-mail:;

Received 5 July, 2016

Accepted 28 November, 2016

St Louis Children's Hospital Foundation.

The authors report no conflicts of interest.

© 2017 by Mutaz B. Habal, MD.