Long-term Outcomes of a Modified Straight-line Palate Repair Technique: Low Speech Correcting Surgery and Fistula Rates
Sasha Lasky, Naikhoba C O Munabi, Marah Jolibois, Idean Roohani, Tayla Moshal, Zachary Collier, Priyanka Naidu, Eric S. Nagengast, Erin M. Wolfe, William P. MageeBackground:
The goal of cleft palate (CP) repair is to restore normal speech, however, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high. We present a modified straight-line palate repair (SLR) technique that facilitates velum length to alleviate VPI. The technique releases nasal mucosa with the levator muscle off the hard palate. This study assesses speech outcomes of this modified SLR technique. Secondary aims are to assess fistula outcomes.
Methods:
A retrospective review evaluated non-syndromic patients with Veau III or IV CP ± cleft lip who underwent SLR from 1993-2023. Patients undergoing modified SLR were compared to those receiving traditional SLR. Outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and velopharyngeal insufficiency (VPI) correcting surgery rates. Multivariable logistic regression was performed.
Results:
Overall, 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4±5.3 years. Modified SLR was associated with fewer fistulas than traditional SLR (3.1% vs 15.3%, Odds Ratio [OR]: 0.19; p=0.001), lower fistula repair rates (0.6% vs 13.1%, OR: 0.26; p=0.022), and lower secondary speech surgery rates (0.8% vs 16.0%, OR: 0.046; p=0.003).
Conclusion:
The modified SLR technique resulted in lower rates of VPI surgery, as well as fewer fistulas and lower rates of fistula repairs compared to traditional SLR at six years postoperatively. We hypothesize that releasing the nasal mucosa off the hard palate facilitates more posterior positioning of the levator muscle and less restricted medial mobilization of the oral mucosa, which lengthens the velum to alleviate VPI.