A Comparison of Three Methods of Repairing the Hard Palate

Abstract

Objective To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. Patients Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. Interventions Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. Outcome Measures For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. Results There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p = .01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. Conclusions Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study

“…[1][2][3][4][5][6]11 Different management protocols have different impact on the development of craniofacial morphology. 4,7,8,13,15,[17][18][19]24,[27][28][29] This study has compared the craniofacial morphology of children with complete unilateral cleft lip and palate treated with three different surgical protocols, the only difference which is in the technique employed to perform hard palate closure.…”

“…The authors are convinced that the key factor for positive craniofacial morphology in group III was avoidance, if possible, of hard palate mucoperiosteal flap elevation and mobilization. Many authors 4,15,17 have also demonstrated that such separation is responsible for the growth-inhibiting formation of palate scar tissue. Many of them mention reduction of the body of the maxilla in patients treated for complete unilateral cleft lip and palate.…”

“…Several papers have investigated craniofacial morphology in children with cleft disorders, 2,14,21,25 but there are only a handful of cross-center trials indicating the impact of different surgical protocols on craniofacial growth and development. 1,[3][4][5][6]11,15,18,22,24,27 A large number of different surgical treatment techniques and varied assessment criteria impede the formulation of an optimum treatment method.…”

Speech development in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair: A longitudinal perspective

“…We hope that the Scandcleft project will also give information about the impact of surgical technique on speech development. So far, we know of no significant differences in speech results as a result of different techniques for closing the cleft in the hard palate [18,19].…”

The efficacy of vomer flap for closure of hard palate during primary lip repair

“…The favourable growth that has been reported in the past is based on the proviso that no lateral relaxing incision was used during the second stage of cleft-palate repair. 11 This means that if the surgeon has used lateral relaxing incisions or if the flap has not survived in all the cases, the aforementioned advantages of the flap are not valid. Specifically, these issues will be discussed in this study.…”