43. What Predicts Postoperative Palate Length Gained? A Study of Patients Treated By An International Cleft Ngo

PURPOSE: Assessing outcomes of cleft palate (CP) repair in patients from low-and-middle income countries (LMICs) remains a challenge. In an initiative to improve patient outcomes using data, Operation Smile has begun using gain in palatal length as a metric to assess operation outcome. This measurement can be utilized in LMIC settings, with greater gain in length suggesting successful retro-positioning of the palatal muscular and potentially better speech results. We aimed to assess the predictors of the gain in palatal length in the immediate postoperative period. METHODS: A retrospective chart review of all patients undergoing CP repair between 2021-2024 on Operation Smile programs was conducted. Data collected included patient demographics, program country, preoperative measurements, postoperative measurements, surgical technique and intraoperative maneuvers (ex. Vomer flap). Postoperative palate measurements were taken on table at the conclusion of the case. Measurements taken were cleft width ratio (CWR) measured at the hard-soft junction and pharyngeal length was measured from uvular tip to the posterior wall of the pharynx. Gain in palate length was calculated as the difference in pharyngeal length pre and post-operatively. Correlation coefficients were calculated between preoperative and postoperative measurements. Simple and multivariate linear regression models were fit to determine factors that impact palatal length gained. RESULTS: A total of 258 patients were included. Mean cleft width was 13.7±3.4 mm, mean cleft width ratio (CWR) was 0.3±0.08, and the mean gain in palatal length was 8.1±5.0 mm. The most common palatoplasty technique utilized was the two flap (n=106, 41.1%) and the most common level of muscle dissection was to the mid palate (n=154, 59.7%). In 127 (49.2%) cases, use of a vomer flap was reported. The proportion of patients that obtained no gain in palatal length was 3.9% (n=10). Pearson correlation coefficient between preoperative CWR and gain in palatal length was 0.08. Simple linear regression found no relationship between CWR and gain in length (p=0.22). Surgical technique had no association with gain in length (p>0.05) on both simple and multivariate regression. Intraoperative maneuvers such as the use of a vomer flap (p=0.002) and separation of the muscle from the posterior palate (p=0.03) were both found to predict an increase in palatal length gained on multivariate linear regression. CONCLUSION: Preoperative cleft width severity was found to be a poor predictor of immediate postoperative gain in palatal length. Certain intraoperative maneuvers such as use of a vomer flap and separation of the muscle from the posterior palate were found to increase palatal length. Long-term follow up will be required to further assess the impact of cleft severity and technique selection on outcomes. Furthermore, long-term outcomes will allow for evaluation of gain in palatal length as a measurement in predicting need for further speech surgery.