Primary Surgical Treatment of Cleft Palates in the Algerian Hospital Environment

Abstract

It is widely acknowledged that cleft palate is one of the most common craniofacial malformations. It requires multidisciplinary care composed mainly of a speech therapist, a radiologist, a psychologist, and above all a pediatric surgeon. It should be noted that the closing of this cleft represents a challenge for the pediatrician who above all seeks to restore the anatomical relationships that are compatible with the velopharyngeal competence that is required for the proper functioning of phonation, swallowing, ventilation, and hearing. Otherwise, the child may develop velopalatine incompetence which can cause a phonatory problem that may remain poorly tolerated by the patient and those around him. This phonatory problem represents a major concern for parents. In addition, the classic surgical technique of _Veau – Wardill - Kilner palatoplasty_ consists of dissecting the nasal and oral mucous membranes of the palatal tablets which are sutured along the midline without intravelar myopathy. In the literature, the velar insufficiency rate of this technique is reported as between 15 and 26%. In addition, over the last twenty years, the techniques for reconstructing velopalatine clefts have remarkably progressed. As an example, it is worth citing the Sommerlad intravelar veloplasty (IVV) and the Furlow Z veloplasty which are the most anatomical technique as they both allow repositioning the velar muscles thus leading to an improvement in the lifting and receding movements of the veil, which significantly reduces the sequelae. The goal of the present work, which is based on a sample of 85 cases, is to make an epidemiological, therapeutic, and evolutionary analysis, and also to take stock of the surgical techniques practiced in our country for the primary treatment of cleft palates. It was found that the velar insufficiency rate was much higher after classical palatoplasty than after primary surgery with intravelar veloplasty or Furlow’s Z-plasty.