Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Abstract

Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes. Materials and Methods: A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed. Results: Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-toY pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared. Conclusions: The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-toY pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.

Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type

“…13 In current literature, different approaches are presented for the treatment of patients with cleft palate and with conductive hearing loss due to effusion in the tympanic cavity. [14][15][16][17] Paracentesis and tympanostomy tube surgery (TTS) are the main treatment options for correcting middle ear dysfunction. This study evaluates the prevalence of tympanostomy tube placement in patients with cleft deformities in relation to the absolute and relative cleft width and cleft classification.…”

Non routine use of alveolar incision in Von Langenbeck technique palatoplasty in children; a safe and viable technique in our centre

“…22 A longer period of follow up would have given more information about the incidence of otitis media and hearing disturbances in this repair technique as it is still argued whether or not the technique of palatoplasty has a bearing with the development of such complications. 23,24 These parameters would have given further insight into the benefit or otherwise of our technique modification.…”

Cleft Palate Repair: A History of Techniques and Variations

“… 35 , 38 , 39 Furthermore, both Sommerlad’s and Furlow’s techniques were found to be associated with the lowest rates of middle ear dysfunction and need for tympanostomy tubes. 40 …”