Assessment of velopharyngeal insufficiency and oronasal fistula after primary surgery of cleft palate

Adil Lekhbal; Omar Wydadi; Hicham Lyoubi; Anas Bouzbouz; Redalah Abada; Sami Rouadi; Mohamed Roubal; Mohamed Mahtar

doi:10.18203/issn.2454-2156.IntJSciRep20202640

Authors

Adil Lekhbal Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Omar Wydadi Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Hicham Lyoubi Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Anas Bouzbouz Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Redalah Abada Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Sami Rouadi Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Mohamed Roubal Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco
Mohamed Mahtar Department of ENT, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Centre IBN ROCHD, Casablanca, Morrocco

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20202640

Keywords:

Cleft palate, Velopharyngeal insufficiency, Oronasal fistula

Abstract

Background: Cleft palates are the most common congenital craniofacial anomalies in children, and their treatment is challenging in terms of outcomes. The objective of the study was to determine the incidence of velopharyngeal insufficiency (VPI), and of the oronasal fistula after a veloplasty.

Methods: By a retrospective study, over a period of 2 years, going from January 2017 to December 2018, carried out in the department of ENT and head and neck surgery of the August 20 hospital in Casablanca, Morocco. The inclusion criteria were all patients operated on for a cleft palate. The main results were the incidence of VPI, and of the oronasal fistula after a primary repair of the palate.

Results: Out of a total of 21 cases, the average age was 4 years, and the sex ratio was 0.61, the average postoperative follow-up duration was 1 year and 9 months. VPI was found in 13 patients (62%), it was mild in 3 patients (14%), moderate in 6 patients (28%), and severe in 4 patients (19%), the frequency of VPI increased significantly with increasing age (p=0.05). The oronasal fistula was found in 5 (23.8%) patients, this fistula was more frequent when the patient benefited from the operation at an early age.

Conclusions: Age is the most important factor in the management of cleft palates.

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References

Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, et al. National estimates and race/ethnic-specific variation of selected birth defects in the United States. Birth Defects Res A Clin Mol Teratol. 2006;76(11):747-56.

Crockett DJ, Goudy SL. Cleft Lip and Palate. Facial Plast Surg Clin North Am. 2014;22(4):573-86.

Kaufman FL. Managing the cleft lip and palate. Pediatr Clin NA. 1991;38(5):1127-47.

Strauss RP. The organization and delivery of craniofacial health services: state of the art. Cleft Palate Craniofac J. 1999;36(3):189-95.

Dalston RM, Marsh JL, Vig KW, Witzel MA, Bumsted RM. Minimal standards for reporting the results of surgery on patients with cleft lip, cleft palate, or both: a proposal. Cleft Palate J. 1988;25:3-7.

Inman D, Thomas P, Hodgkinson PD, Reid CA. Oro-nasal ﬁstula development and velopharyngeal insufﬁciency following primary cleft palate surgery - an audit of 148 children born between 1985 and 1997, Br J Plast Surg. 2005;58:1051-4.

Phua YS, de Chalain T. Incidence of oronasal ﬁstulae and velopharyngeal insufﬁciency after cleft palate repair: an audit of 211 children born between 1990 and 2004, Cleft Palate Craniofac J. 2008;45:172-8.

David DJ, Anderson PJ, Schnitt DE, Nugent MAC, Sells R. From birth to maturity: a group of patients who have completed their protocol management. Part II. Isolated cleft palate. Plast Reconstr Surg. 2006;117:515-26.

Marrinan EM, LaBrie RA, Mulliken JB. Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type. Cleft Palate Craniofac J 1998;35:95-100.

Chapman KL, Hardin-Jones MA, Goldstein JA, Halter KA, Havlik RJ, Schulte J. Timing of palatal surgery and speech outcome. Cleft Palate Craniofac J. 2008;45:297-308.

Dorf DS, Curtin JW. Early cleft palate repair and speech outcome. Plast Reconstr Surg. 1982;70:74-81.

Hosseinabad HH, Derakhshandeh F, Mostaajeran F, Abdali H, Davari HA, Hassanzadeh A. 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. Int J Pediatr Otorhinolaryngol. 2015;79(10):1722-6.

Chait L, Gavron G, Graham C, Noik E, Aguiar GD. Modifying the two-stage cleft palate surgical correction. Cleft Palate Craniofac J. 2002;39:226-32.

Lu Y, Shi B, Zheng Q, Hu Q, Wang Z. Incidence of palatal ﬁstula after palatoplasty with levator veli palatini retropositioning according to Sommerlad, Br J Oral Maxillofac Surg. 2010;48:637-40.

Cohen SR, Kalinowski J, LaRossa D. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg. 1991;87:1041-7.

Rohrich RJ, Rowsell AR, Johns DF. Timing of hard palatal closure: a critical long-term analysis. Plast Reconstr Surg. 1996;98:236-46.

Friede H, Enemark H. Long-term evidence for favorable midfacial growth after delayed hard palate repair in UCLP patients. Cleft Palate Craniofac J. 2001;38:323-9.