Primary Versus Secondary Repair of Cleft Palate Using Intravelar Veloplasty Approach

Abstract

INTRODUCTION:Cleft palate is a common congenital anomaly of the craniofacial region. Intravelar veloplasty is a procedure for correcting cleft palate depends on dissection and retro-positioning of levator palati muscle from the posterior line of hard palate. Velopharyngeal insufficiency requires palatal re-repair procedure. The present study aimed to evaluate the microscopic surgical repair of CP with IVVP on clinical and radiological basis. METHODS:The study was conducted using a comparative quasi-experimental study design on 35 patients; 21 patients underwent primary IVVP repair and 14 patients underwent palatal re-repair. Postoperative outcomes were assessed immediately after surgery and after 6 months. Clinical assessment included cleft types and complications, while the radiological assessment was through lateral videofluoroscopy and nasopharyngoscopy. RESULTS: Primary cleft palate repair was done for 21 patients of which 57.1% were females, while cleft palate re-repair was done for 14 patients of which 50% were females. There was a significant difference between primary and re-repaired cases in regard to residence, weight, height and type of cleft, while the complications showed insignificant difference. Primary and re-repaired cases showed insignificant difference in the parameters at nasopharyngoscopy except for closure ratio change and lateral video fluoroscopy except for resting and contracting gaps changes. CONCLUSION AND RECOMMENDATIONS: Only small rate of oronasal fistula following IVVP was found with significant improvement in velopharyngeal function and complete correction of velopharyngeal incompetence of secondary cleft palate repair following different operational techniques. IVVP is a minimally invasive procedure for correcting cleft palate both for primary or secondary repair.