Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty

Abstract

Submucous cleft palate (SMCP) is a relatively rare variant of the common pathology of cleft palate with specific anatomic and clinical features. Even though there are many surgical options defined previously to correct the SMCP, correction of the velopharyngeal insufficiency and obtaining ideal speech results remains as a challenge. The aim of this article was to compare the speech benefits of Furlow double opposing Z plasty and posterior pharyngeal flap operation combined with intravelar veloplasty for the correction of SMCP using objective assessment tools. This study reviewed 29 patients who underwent either superiorly based posterior pharyngeal flap combined with intravelar veloplasty or Furlow palatoplasty for submucous cleft palate repair between years 2005 and 2011. The mean standard deviation age at palate repair was 123.6 ± 65.8 months and the mean follow-up period was 31.2 ± 15.9 months. The postoperative results demonstrated that in both groups significantly correction has been achieved in means of velopharygeal closure (P values for Furlow and pharyngeal flap groups are 0.012 and 0.001 respectively). The correction of the nasalance scores obtained depending on the surgical procedure for /şa/ and /ka/ syllables demonstrated significantly more benefit with pharyngeal flap combined with intravelar veloplasty than Furlow palatoplasty (P = 0.026 for each). In the treatment of submucous clefts, both Furlow palatoplasty and pharyngeal flap procedure combined with intravelar veloplasty appear to be effective whereas for the patients having significant signs of hypernasality, contribution of pharyngeal flap may be taken into consideration.

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate—A systematic review

“…Studies only reporting postoperative results were excluded from this table. Despite reporting preoperative nasalance scores, data from Calis et al () were excluded here as results were not independently comparable with other studies—that is, they were reported separately for each syllable and no summative or normative values were included. Phonology and language data reported in Schönweiler et al's () study were also excluded as they were grouped with other forms of orofacial clefting and not specific to SMCP.…”

“…Evidence supporting the impact of surgery type on postoperative speech outcomes was mixed (Afrooz et al, ; Calis et al, ; Ezzat et al, ; Park et al, ). Afrooz et al () and Ezzat et al () reported no significant difference in postoperative velopharyngeal functioning between (a) radical intravelar veloplasty and modified Furlow palatoplasty; and (b) radical intravelar veloplasty and V–Y pushback pharyngoplasty with intravelar veloplasty, respectively.…”

“…However, they reported that participants receiving a pharyngeal flap achieved greater overall velopharyngeal functioning when compared with those who received a pushback palatoplasty. Calis et al () reported mixed nasalance results for Furlow palatoplasty and posterior pharyngeal flap with intravelar veloplasty across different speech stimuli, with an overall favour for the latter procedure.…”

“…Outcome data included hearing status, perceptual and instrumental (e.g., nasometry) speech measures, language abilities, and instrumental measures of velopharyngeal functioning (e.g., nasoendoscopy and videofluoroscopy). Finally, reviewers noted factors reported to impact speech and language outcomes in respective studies, for example: surgery type (Afrooz et al, 2015;Calis et al, 2018;Ezzat, El-Begermy, Eid, & Akel, 2016;Park et al, 2000), age at surgery (Baek et al, 2017;Bezuhly et al, 2012;Oji et al, 2013;Swanson et al, 2017) and preoperative speech characteristics (Baek et al, 2017;Bezuhly et al, 2012).…”

“…Remaining studies compared outcomes based on surgery (Afrooz et al, 2015;Ezzat et al, 2016;Park et al, 2000), cleft type (Park, Bae, Nam, Kang, & Sung, 2016;Schönweiler et al, 1999;Seagle et al, 2016) and age at surgery (Kwon et al, 2018;Swanson et al, 2017). Nine studies examined only nonsyndromic SMCP groups (Baek et al, 2017;Calis et al, 2018;Calnan, 1954;Isotalo et al, 2007;Kwon et al, 2018;Oji et al, 2013;Seagle, Patti, Williams, & Wood, 1999;Swanson et al, 2017; ten Dam et al, 2013). Eight studies documented anatomical features at time of diagnosis; however, these were unspecific in two studies (Ng et al, 2015;Oji et al, 2013).…”