Optimal Timing of Palatoplasty in Infants With Comorbidities

Abstract

Objective: Ideal timing of palatoplasty continues to be debated given that early repair is thought to improve speech and hearing, whereas delayed repair is associated with less midface growth disruption. The purpose of this study is to elucidate optimal timing of palatoplasty in patients with comorbidities to mitigate perioperative complications. Design: Retrospective cohort study. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program Pediatric. Patients: Palatoplasty performed for children younger than the age of 2 years with comorbidities. Outcomes: Medical/surgical complications, reoperations, readmissions within 30 days postoperatively. Results: Patients with comorbidities having Veau I or II cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 125 days of age ( P < .001). Patients with comorbidities having Veau III cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 225 days of age ( P = .010). Patients with comorbidities having Veau IV cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 250 days of age ( P = .045). Conclusions: Infants with comorbidities having progressively increasing Veau classification demonstrate unique age-dependent perioperative thresholds, such that more extensive phenotypes are associated with better perioperative outcomes with older age at time of cleft palate repair.

Speech Outcomes following Mandibular Distraction Osteogenesis for Robin Sequence: Midchildhood Results

“…The literature demonstrates that palatal closure by 15 months of age before learning nonnasal pressure consonants is associated with improved speech and hearing. 26,29,30 In our study, RSCP patients had CP repair slightly later than CP-only patients, and this may be reflective of the sentiment that later repair may allow for lower rates of airway complications in slightly older, larger infants. [31][32][33][34][35] Our data show that delay of CP repair was associated with worse speech outcomes in both groups-RSCP and CP only-in visible nasal emissions, resonance, and compensatory articulation.…”

“…17,24 Both cohorts saw worsening speech outcomes, namely, errors in articulation, with delays in the timing of CP repair, an interesting finding given the general recommendations regarding timing of CP repair in both RSCP and CP only. 19,[26][27][28][29][30] Despite detailed investigations into the impact of timing of CP repair on speech outcomes, there is a paucity of information on timing of CP repair in MDO-treated RSCP patients. The literature demonstrates that palatal closure by 15 months of age before learning nonnasal pressure consonants is associated with improved speech and hearing.…”

“…17,24 Both cohorts saw worsening speech outcomes, namely, errors in articulation, with delays in the timing of CP repair, an interesting finding given the general recommendations regarding timing of CP repair in both RSCP and CP only. 19,26–30…”

“…[31][32][33][34][35] Our data show that delay of CP repair was associated with worse speech outcomes in both groups-RSCP and CP only-in visible nasal emissions, resonance, and compensatory articulation. 26,[28][29][30] Additional prospective study on timing of CP repair in Veau class I and Veau class II clefts, with or without Robin sequence, may be warranted to determine whether this association is related to any particular variable and to establish causation.…”

Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion

“…In our clinical experience, we have noted that delays in CP repair have long term detriments to speech as evaluated by the Pittsburgh Weighted Speech Scale. That stated, there is data to suggest that palatal closure by 15 months of age prior to learning palate-related sounds is associated with improved speech and hearing (Rohrich et al, 1996; Shaffer et al, 2020;Kalmar et al, 2020). This data is also important in the backdrop of increasing reports of speech difficulties in the RS group (Stransky et al, 2013; Schwaiger et al, 2021).…”