Long-Term Outcomes of a Modified Straight-Line Palate Repair Technique: Low Speech-Correcting Surgery and Fistula Rates.

BACKGROUND

A primary goal of cleft palate (CP) repair is to restore normal speech; however, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high. The authors present a modified straight-line palate repair (SLR) technique that facilitates velum length to alleviate VPI. The technique releases nasal mucosa with the levator muscle off the hard palate. The authors assessed speech outcomes of this modified SLR technique. A secondary aim was to assess fistula outcomes.

METHODS

A retrospective review was performed to evaluate nonsyndromic patients with Veau III or IV CP ± cleft lip who underwent SLR from 1993 through 2023. Patients undergoing modified SLR were compared with those receiving traditional SLR. Outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and VPI correcting surgery rates. Multivariable logistic regression was performed.

RESULTS

Overall, 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4 ± 5.3 years. Modified SLR was associated with fewer fistulas than traditional SLR (3.1% versus 15.3%; odds ratio [OR], 0.19; P = 0.001), lower fistula repair rates (0.6% versus 13.1%; OR, 0.26; P = 0.022), and lower secondary speech surgery rates (0.8% versus 16.0%; OR, 0.046; P = 0.003).

CONCLUSIONS

The modified SLR technique resulted in lower rates of VPI surgery, as well as fewer fistulas and lower rates of fistula repairs compared with traditional SLR at 6 years postoperatively. The authors hypothesize that releasing the nasal mucosa off the hard palate facilitates more posterior positioning of the levator muscle and less restricted medial mobilization of the oral mucosa, which lengthens the velum to alleviate VPI.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.