Nontraditional velopharyngoplasty predictor unveiled

By Piriya Mahendra, medwireNews Reporter

The necessity of subsequent velopharyngoplasty (VPP) does not depend on the time of soft palate closure and type of cleft, say researchers.

T Schuster (University Hospital Basel, Switzerland) and colleagues found that 25.6% of the 1300 patients with soft cleft palate included in their study required secondary VPP for speech improvement after soft palate closure.

As reported in the Journal of Craniomaxillofacial Surgery, the age of the patients at the time of operation, primary or secondary soft palate closure, and the type of clefting were not significant factors for performing a subsequent VPP.

However, Schuster and team found significant differences with respect to the need for a second VPP according to surgical experience of the operating surgeons. Indeed, the higher the number of previous soft palate occlusions and VPPs performed by a particular surgeon, the significantly higher the number of subsequent VPPs they deemed necessary for each patient.

"These findings might be explained by the fact that on one hand the most experienced surgeon was assigned with uncommon or difficult cases whereas a VPP might be sometimes predictable," write the authors.

The study involved 1723 patients, 1300 (75.45%) of whom had soft cleft palate syndrome and were treated at the Bremen-Mitte Clinic cleft centre in Switzerland between 1974 and 1999. Overall, 954 of the patients with soft cleft palate syndrome had cleft lip and palate, while 346 had isolated cleft palate.

The authors say that the findings from their large retrospective survey "allow for a precise observation of the distribution model of cleft types, the operative approach, and their results within a geographical region." They add that the survey could "lead to important findings both for the present and future."

Schuster and colleagues note that their findings support those of previous studies. "The necessity of VPP depends not on the time of soft palate closure within the first year of life and the type of clefting, but mostly on individual factors," they conclude.

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