Impact of pharyngofixation in cleft palate repair surgery on the development of chronic adhesive otitis media

Otruba, Lukáš; Schalek, Petr; Hornáčková, Zuzana

doi:10.1017/s0022215117000664

Cited by 4 publications

(4 citation statements)

References 16 publications

(30 reference statements)

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“…OME in patients with cleft palate, or without cleft lip, has been extensively investigated in recent years. 27 There remains debate over the optimal surgical technique and management strategies for cleft palate repair, particularly regarding their influence on middle ear function. 17 While consensus is not unanimous about the impact of primary palatoplasty on audiological outcomes, a significant body of research posits that palate repair can restore soft palate integrity, improve palatal muscle architecture, enhance eustachian tube function, and subsequently decrease the risk of OME.…”

Section: Discussionmentioning

confidence: 99%

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The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

Kazemi,

Nabavizadeh,

Nadjmi

et al. 2024

Laryngoscope Investig Oto

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ObjectiveOtitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes.MethodsIn this retrospective‐prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration.ResultsThe mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90–1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20–16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: −6.58 [95% CI: −10.43 to −2.73], p‐value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: −1.10; 95% CI: −1.85 to −0.36, p‐value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings.ConclusionsAlthough the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes.Level of Evidence3b.

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Section: Discussionmentioning

confidence: 99%

“…OME in patients with cleft palate, with or without cleft lip, has been extensively investigated in recent years 27 . There remains debate over the optimal surgical technique and management strategies for cleft palate repair, particularly regarding their influence on middle ear function 17 .…”

Section: Discussionmentioning

confidence: 99%

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

Kazemi,

Nabavizadeh,

Nadjmi

et al. 2024

Laryngoscope Investig Oto

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“…We are unable to comment on this with our data, as many of the studies explicitly included or excluded cholesteatoma in patients with cleft palate and controls, therefore skewing our findings. Furthermore, while there is limited evidence concerning the effects of palatoplasty on cholesteatoma occurrence, 1 study found that supplementing palatoplasty with an inferior or superior pharyngeal flap did not decrease the risk of cholesteatoma 85 . Another study noted that adults with previously repaired submucous cleft palates were more likely to have cholesteatoma 86 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, while there is limited evidence concerning the effects of palatoplasty on cholesteatoma occurrence, 1 study found that supplementing palatoplasty with an inferior or superior pharyngeal flap did not decrease the risk of cholesteatoma. 85 Another study noted that adults with previously repaired submucous cleft palates were more likely to have cholesteatoma. 86 Overall, while patients with cleft palate have an elevated risk of cholesteatoma, this study could not comment on their recurrence rates after tympanomastoidectomy as compared with control patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Tympanoplasty After Cleft Palate Repair: A Systematic Review and Meta‐analysis

Poupore

Smaily

Carroll

et al. 2022

Otolaryngol.--head neck surg.

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Objective To analyze graft success rates and hearing outcomes in patients with a history of cleft palate (CP) repair undergoing tympanoplasty. Data Sources PubMed, Scopus, and CINAHL. Review Methods Per PRISMA guidelines, the databases were searched from date of inception through December 14, 2021. Studies of patients with previous CP repair who underwent tympanoplasty were included. Meta-analysis of proportions, continuous measures, odds ratios (ORs), and meta-regression were used to analyze graft success and hearing outcomes after tympanoplasty. Results A total of 323 patients with CP repair and 1169 controls were included. The proportion of graft success was 86.7% (95% CI, 76.1%-94.5%) in patients with CP repair and 88.8% (95% CI, 76.9-96.8) in controls. There was no difference in odds of graft success between patients with CP repair and controls (OR, 1.0 [95% CI, 0.5-1.8]; P = .870). Age was not a significant moderator of graft success in patients with CP repair ( r = 0.1 [95% CI, −0.2 to 0.3]; P = .689) or controls ( r = −0.0 [95% CI, −0.1 to 0.1]; P = .952). Comparing mean differences between pre- and postoperative air-bone gap was not statistically significant in patients with CP repair and controls (0.2 dB [95% CI, −3.1 to 3.4]; P = .930). Odds of functional success (postoperative air-bone gap <20 dB) were not different between the groups (OR, 0.8 [95% CI, 0.5-1.4]; P = .450). Conclusion This meta-analysis does not endorse anatomic or functional differences between patients with CP repair and controls after tympanoplasty. However, there is a paucity of evidence for younger children. Further studies are warranted to elucidate specific risk factors for tympanoplasty outcomes in young patients with previous CP repair.

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Modern Cleft Palate Repair: Controversies, Surgical Techniques, and Postoperative Care

Denadai¹,

2022

Current Concept in Cleft Surgery

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Impact of pharyngofixation in cleft palate repair surgery on the development of chronic adhesive otitis media

Abstract: Pharyngofixation did not significantly alter the severity of long-term otological findings.

Cited by 4 publications

References 16 publications

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

Outcomes of Tympanoplasty After Cleft Palate Repair: A Systematic Review and Meta‐analysis

Modern Cleft Palate Repair: Controversies, Surgical Techniques, and Postoperative Care

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