Levator muscle reconstruction: does it make a difference?

Eighty-five children from 6 to 8 months of age underwent palatal reconstruction between 1972 and 1978. Forty had palatal repair without levator reconstruction, and 45 had an intravelar veloplasty. Speech assessment was performed at 2 years after surgery. Any nasal escape or hypernasality, whether consistent or not, was included as abnormal speech. The data revealed that 70 percent (28 of 40) had abnormal speech when no muscle reconstruction was performed compared with 63 percent (24 of 45) after having had an intravelar veloplasty. We conclude that the added operative dissection adds no morbidity to the procedure and that the improved speech results probably justify performing an intravelar veloplasty when doing a palatal repair.