The authors’ purpose was to document speech outcome after cleft palate repair in patients with syndromic versus nonsyndromic Robin sequence. They also report the results of secondary correction of velopharyngeal insufficiency using a superiorly based pharyngeal flap or double-opposing Z-palatoplasty.
Charts of patients with Robin sequence and cleft palate between 1980 and 2007 were reviewed. Data collected included date of birth, sex, syndrome/association, cleft palatal type (Veau class I or II), age at palatoplasty, incidence of palatal fistula, postoperative speech assessment, videofluoroscopic results, need for secondary operation for velopharyngeal insufficiency, and type of secondary operation (pharyngeal flap or double-opposing Z-palatoplasty).
The authors identified 140 patients with Robin sequence who had palatal closure. Postoperative speech evaluation was available for 96 patients (69 percent). A syndrome or association was identified in 42 patients (30 percent). Primary palatoplasty was successful in 74 patients (77 percent); speech was characterized as competent and competent to borderline competent. The authors found a significantly higher incidence of velopharyngeal insufficiency following palatal repair for syndromic (38 percent) than nonsyndromic Robin sequence (16 percent). (p = 0.039). In patients with velopharyngeal insufficiency, competent or borderline competent speech was determined after double-opposing Z-palatoplasty (two of five patients) or pharyngeal flap (eight of 10 patients).
The rate of velopharyngeal insufficiency in syndromic Robin sequence is significantly greater than in nonsyndromic Robin sequence. The authors prefer pharyngeal flap for velopharyngeal insufficiency in patients with Robin sequence, whether syndromic or nonsyndromic, without retrognathism or signs/symptoms of obstructive sleep apnea.
From the Craniofacial Center and Department of Plastic and Oral Surgery, Children’s Hospital and Harvard Medical School.
Received for publication March 25, 2012; accepted April 19, 2012.
Presented in part at the 69th Annual Meeting of the American Cleft Palate Association, in San Jose, California, April 17 through 21, 2012.
Disclosure:None of the authors has any financial disclosures or commercial associations that might suggest a conflict of interest in relation to this work.
John B. Mulliken, M.D., Department of Plastic and Oral Surgery, Children’s Hospital, 300 Longwood Avenue, Boston, Mass. 02115, firstname.lastname@example.org