Heng Yin

Incidence of postoperative velopharyngeal insufficiency in late palate repair.

Background This was a study of patients with cleft palate who for various reasons have their first hospital visit for palatal repair at an older age in developing countries. The aims of this study were to investigate the incidence of postoperative velopharyngeal insufficiency in Chinese patients with late palatal repair and to determine the relative importance of age at palatoplasty, cleft type, surgical technique, and experience for clinical outcomes. Methods A cohort of 224 patients who underwent primary palate repair were studied retrospectively. Speech outcomes were evaluated based on the severity of hypernasality and nasal emission. The percentage of cases that required a second operation was recorded. The related factors were analyzed, and a logistic regression model was applied. Results The mean age at palatoplasty was 5.6 (SD, 4.6) years (age range, 2–24 years of age); 29.9% of the cases required a second operation. Age at palatoplasty was the only significant contributing factor for the percentage of patients who needed a second surgery. Each additional year in age at palatoplasty was associated with a 10.8% increase in odds of requiring a second surgery (P = 0.002; odds ratio, 1.108; confidence interval, 1.038–1.182). However, cleft type, surgical technique, and surgeon’s experience did not influence clinical outcomes. Conclusions Primary palate repair at older than 2 years resulted in acceptable clinical speech outcomes in our patient population, there was an increase in the incidence of postoperative velopharyngeal insufficiency with increasing age at the time of palatoplasty. There was no correlation with cleft type, surgical technique, or surgeon’s experience.

Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate

OBJECTIVE To address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. MATERIALS AND METHODS Forty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6-12 months and cleft palate repair at age 18-30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov-Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal-Wallis H tests were used for multiple comparisons. RESULTS Both case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p < 0.05) and retrusion of the maxilla (S-Ptm, p < 0.05), A point and ANS point (Ba-N-A, Ba-N-ANS, p < 0.05). Patients treated with two-stage palate repair had a reduced posterior maxillary vertical height (R-PMP, p < 0.05). CONCLUSIONS Our results indicated that maxillary sagittal length and position could be perturbed by both one- and two-stage palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years.

Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type.

PurposeThe aim of this study was to investigate the relevance of sex, age, and cleft type to velopharyngeal function after primary Sommerlad palatoplasty so as to improve velopharyngeal function after the procedure. Patients and MethodsRecords of 503 patients with nonsyndromic cleft palate after primary Sommerlad palatoplasty were included in the retrospective study. Relevance between their velopharyngeal function and sex, age, and cleft type was analyzed. Statistical analysis was performed using SPSS 13.0 (SPSS Inc., Chicago, IL). ResultsThere were no significant differences of velopharyngeal competence (VPC) rates between different sexes (P = 0.635). Specifically, VPC rates were significantly higher in younger-than-2-years groups than in older age groups (P < 0.05) and significantly lower in 6-years-or-older group (P < 0.05). No differences were found among 2- to 6-year-old groups (P > 0.05). The VPC rates were significantly lower in the bilateral complete cleft palate and the unilateral complete cleft palate than in the incomplete cleft palate before 2 years old (P < 0.05), whereas there were no significant differences totally (P = 0.875). Results showed that the disparity of the VPC rate among different cleft types would decrease with age. Moreover, results of multivariate logistic regression also indicated that operation age and cleft type are factors influencing velopharyngeal function. ConclusionsPrimary palatoplasty should be completed before 2 years old, and the postoperative velopharygeal function will greatly decreases after 6 years old. The influence of cleft type on velopharyngeal function is limited to young patients. For those who have missed the best surgical timing, appropriate delay of operation age is reasonable, especially for patients with complete cleft palate. For patients 4 to 6 years old, the first choice is still simple palatoplasty no matter which cleft type they are classified into.

Analysis of the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair

OBJECTIVE The objective of this study was to analyze the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair. STUDY DESIGN Ninety-five nonsyndromic patients with cleft palate were enrolled. Two surgical techniques were applied in the patients: simple palatoplasty and combined palatoplasty with pharyngoplasty. All patients were assessed 6 months after the operation. The postoperative velopharyngeal closure (VPC) rate was compared by χ(2) test and the correlative factors were analyzed with logistic regression model. RESULTS The postoperative VPC rate of young patients was higher than that of old patients, the group with incomplete cleft palate was higher than the group with complete cleft palate, and combined palatoplasty with pharyngoplasty was higher than simple palatoplasty. Operative age, cleft type, and surgical technique were the contributing factors for postoperative VPC rate. CONCLUSIONS Operative age, cleft type, and surgical technique were significant factors influencing postoperative VPC rate of patients with cleft palate.

What Operative or Anatomic Factors Affect Dental Arch Development in the Cleft Patient

PURPOSE There has been dispute about the exact factors influencing dental arch development in adult cleft palate patients, so we designed this study to investigate the effects of operative and anatomic factors on the development of dental arch morphology. PATIENTS AND METHODS A retrospective cohort study was conducted among 3 groups of patients (operated, unoperated, and normal) from West China College of Stomatology, Sichuan University, Chengdu, China. The differences in dental arch morphology, including length and width of the upper and lower dental arches, inclination of the palatal shelf, and palatal height, were analyzed by variance analysis with SPSS software, version 13.0 (IBM, Armonk, NY). RESULTS We enrolled 90 individuals: 30 unoperated adults with bilateral cleft lip and palate, 30 adults with operated bilateral cleft lip and palate, and 30 normal adults. The widths of all upper and posterior lower arches, lengths of the anterior upper arch, palatal height, and palatal shelf inclination in the operated group were smaller than those in the unoperated group; the lengths and widths of the anterior upper arch were smaller whereas the widths of the posterior upper and lower arches, palatal height, and palatal shelf inclination were greater in the unoperated group compared with the normal group. CONCLUSIONS Operated cleft patients show the most severe deformation of the maxillary arch, especially in the anterior part. There is an intrinsic palatal tissue deficiency in cleft patients, whereas the maxillary arch deformation in unoperated cleft patients is limited to the anterior region only.