Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

Abstract

Objective : Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP. Methodology : Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review. Results : Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment. Conclusions : The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate—A systematic review

“…The absence of randomized controlled trials and reliance on cohort or case study methodology is in line with previous systematic reviews and surveys in the area of cleft lip and palate (de Ladeira & Alonso, ; Gilleard et al, ; Karri, ). The retrospective nature of most studies is likely secondary to the complex nature of diagnosis and treatment decision‐making within this population.…”

“…The absence of randomized controlled trials and reliance on cohort or case study methodology is in line with previous systematic reviews and surveys in the area of cleft lip and palate (de Ladeira & Alonso, 2012;Gilleard et al, 2014;Karri, 2006 (Dixon, Marazita, Beaty, & Murray, 2011;Smyth, 2014;Sommerlad et al, 2004).…”

“…Surgical intervention alters the structure and function of the palate and/or velopharyngeal port to facilitate adequate closure for speech. However, the optimal timing of surgery and suitable operative technique remains controversial (Gilleard et al, ; Oji et al, ; Sullivan et al, ).…”

Submucous cleft palate: from diagnosis to management

“…Various scoring systems have been developed to quantify speech abnormalities; however, there is great variability between centers in the collection and analysis of data (19). As a result, although perceptual speech assessment is the primary method for diagnosing and assessing VPD, indirect objective methods of evaluation, such as nasometry, can also prove useful; especially combined use of nasometry with nasendoscopy provides objective measures of velopharyngeal function (20). Speech is one of the most important parameters to assess when determining the outcome of cleft palate repair or related velopharyngeal surgeries or speech therapy (3,21).…”

“…However, controversy remains regarding which procedure results in the optimal outcome. The main purpose of either surgery is to improve velopharyngeal function (20). Calis et al reported that both Furlow palatoplasty and the pharyngeal flap procedure combined with intravelar veloplasty are effective in the treatment of SMCP; they also suggested a contribution of pharyngeal flap if the patient has significant signs of hypernasality (3).…”