Primary Palatoplasty in Pediatric Patients - A Retrospective Review of Surgical Outcomes

Background and Purpose:

Children born with cleft palate require surgical correction in order to prevent nasal regurgitation of food and in order to create normal palate function for speech. Uncorrected, speech is hypernasal and unintelligible. Normal speech has very few sounds that are normally nasal. In English, there are only three, "m" as in "Mama", "n" as in "no", and "ng" as in "ring". The remaining 43 sounds in English are made with the soft palate (or velum) closing off the nasopharynx, and projecting speech orally. The goal for surgical separation of the nose and mouth at the hard palate (palatoplasty) is to create a complete separation of the nose and mouth at the hard palate and a functioning soft palate that can open and close the nasopharynx appropriately for speech sound.

Unfortunately, primary closure of the palate is not completely successful in all patients. In some patients, an opening (fistula) remains in the (anterior) hard palate allowing food and speech to leak through the nose. A second problem is that the (posterior) soft palate may not be long enough or move far enough to close off the nasopharynx. This is called a velopharyngeal incompetence. These patients may also suffer from nasal regurgitation and hypernasal, unintelligible speech. Both palatal fistula and velopharyngeal incompetence will require secondary surgery. Any information gained from review of surgical outcomes of the primary palatoplasty might improve surgical success and reduce the number of secondary surgeries required. This would reduce possible morbidity to the patient and expense to the families.

The purpose of this review will be to evaluate the outcome of the palatoplasty children and follow through the Center for Craniofacial Disorders at Children's Healthcare of Atlanta on the Scottish Rite campus. The investigators will evaluate for the occurence of palatal fistula and velopharyngeal incompetence.

Summary of Procedures: