The submucous cleft palate: Diagnosis and therapy

• Published in: International journal of pediatric otorhinolaryngology Vol. 75; no. 1; pp. 85 - 88
• Main Authors: Reiter, R, Brosch, S, Wefel, H, Schlömer, G, Haase, S
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-01-2011
• Subjects: Child; Child, Preschool; Cleft Palate - diagnosis; Cleft Palate - surgery; Cohort Studies; Female; Follow-Up Studies; Hearing loss; Humans; Hyper nasal speech; Infant; Laryngoplasty - adverse effects; Laryngoplasty - methods; Male; Mucous Membrane - pathology; Mucous Membrane - surgery; Otolaryngology; Otorhinolaryngologic Surgical Procedures - adverse effects; Otorhinolaryngologic Surgical Procedures - methods; Palate, Soft - abnormalities; Palate, Soft - surgery; Pediatrics; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Recovery of Function; Reoperation; Retrospective Studies; Speech Therapy - methods; Suture Techniques; Treatment Outcome; Velopharyngeal insufficiency; Velopharyngeal Insufficiency - diagnosis; Velopharyngeal Insufficiency - etiology; Velopharyngeal Insufficiency - therapy; Veloplasty; Veloplasty; Hyper nasal speech; Velopharyngeal insufficiency; Hearing loss
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2010.10.015

Abstract Objectives To investigate age of diagnosis, typical symptoms, finding of the palate, therapy options and accompanying diseases. Methods A retrospective analysis of 439 patients with symptomatic submucous cleft palate (SMCP), who received a veloplasty operation (butterfly suture technique developed by Haase) was made. Results SMCP was initially diagnosed at the mean age of 4.9 years. Main symptoms were hyper nasal speech (51%) and conductive hearing loss (45%), which resolved after veloplasty (often in combination with adenotomy and insertion of ventilation tubes). Typical findings of the palate were a lack of posterior nasal spine (68%) and bifid uvula (59%). Following surgery 17.1% required speech therapy and 5.5% needed velopharyngoplasty due to continuing hyper nasal speech. Conclusion SMCP is often diagnosed very late, though symptoms of velopharyngeal insufficiency (hyper nasal speech, Eustachian tube dysfunction) and bifid uvula are present. We therefore recommend that all patients with such findings are examined by an appropriate specialist such as Phoniatrics, Otolaryngologist and Oral-Maxillofacial-Surgeon so that early diagnosis and palatoplasty can be performed. The veloplasty operation (butterfly suture technique) can be recommended as a safe therapy for velopharyngeal insufficiency for patients with symptomatic SMCP.