Type of Primary Surgery and Postoperative Velopharyngeal Function in Patients With Submucous Cleft Palate at 3 years and Older

Palatoplasty and pharyngeal flap are indicated for submucous cleft palate (SMCP) as primary surgical techniques, but there are no rigid criteria regarding the choice of surgical techniques, and appropriate timing of performing surgery is still controversial. In the present study, 37 patients with SMCP who underwent palatoplasty or pharyngeal flap at our hospital were retrospectively reviewed to evaluate the validity of our criteria to choose between palatoplasty or pharyngeal flap for patients with SMCP diagnosed at the age of around 3 years and older, and what factors will contribute to postoperative velopharyngeal function. Statistical tests were conducted to evaluate the relationships between various factors and the primary outcomes. Primary outcomes were velopharyngeal function (classified to level 1-4) and articulation errors within 1 year after surgery. The following factors were compared with the velopharyngeal function and articulation error: sex, age at the primary operation, operation methods, presence or absence of mental retardation, deafness, syndrome, or multiple congenital anomality. Between palatoplasty and pharyngeal flap groups, the ratio of patients with favorable outcomes and less-favorable outcome was similar, with no significant difference. As a factor that may contribute to velopharyngeal function and articulation error, mental retardation in pharyngeal flap surgery group was significantly related to velopharyngeal function and suggested to be a prognostic factor for velopharyngeal insufficiency. Both surgeries resulted in adequate velopharyngeal function within one year after surgery in patients with SMCP who were diagnosed over the age of 3 years and treated according to our protocol.