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Cleft & Craniofacial Surgery

(7) Low Speech Correcting Surgery and Fistula Rates With a Modified Straight-Line Palate Repair Technique

Thursday, September 12, 2024
2:30 PM – 4:00 PM EDT

    Poster Presenter(s)

  • Sasha Lasky, BS

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    South Pasadena, California, United States

    • Co-Author(s)

  • NM

    Naikhoba Munabi, MD, MPH

    Plastic Surgery Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California, United States

  • Marah Jolibois, MS (she/her/hers)

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California, United States

  • Idean Roohani, BS

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California, United States

  • Tayla Moshal, BS

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California, United States

  • ZC

    Zachary Collier, MD

    Plastic Surgery Resident
    Division of Plastic and Maxillofacial Surgery, Keck School of Medicine of USC
    Los Angeles, California, United States

  • EW

    Erin Wolfe, MD

    Plastic Surgery Resident
    Division of Plastic and Maxillofacial Surgery, Keck School of Medicine of USC
    Los Angeles, California, United States

  • PN

    Priyanka Naidu, MBChB, MSc

    Plastic Surgery Resident
    Division of Plastic and Maxillofacial Surgery, Keck School of Medicine of USC
    Los Angeles, California, United States

  • EN

    Eric Nagengast, MD, MPH

    Plastic Surgery Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California, United States

  • WM

    William P. Magee, III, DDS, MD

    Plastic Surgeon Attending
    Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
    Los Angeles, California, United States

Disclosure(s):
Sasha Lasky, BS: No financial relationships to disclose
Tayla Moshal, BS: No financial relationships to disclose
Abstract:

Background: The goal of cleft palate (CP) repair is to restore normal speech. However, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high.1,2 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. Our study aims to assess 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 to 2023. Patients undergoing modified SLR were compared to those receiving traditional SLR. Primary outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and velopharyngeal insufficiency (VPI) correcting surgery rates. Multivariate 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 = .001), lower fistula repair rates (0.6% vs 13.1%, OR: 0.26; P = .022), and lower secondary speech surgery rates (0.8% vs 16.0%, OR: 0.046; P = .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 6 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.References1. Jodeh DS, Nguyen ATH, Rottgers SA. Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database. Plast Reconstr Surg. 2019;143(2):533-539.2. Battle RJ. The past, present, and future in the surgery of the cleft palate. Br J Plast Surg. 1954;7(3):217-228.

A Comparison of Fistula Locations in the Modified versus Traditional SLR Cohorts
The space of Ernst (A) the periosteal elevator sits at the entrance of the avascular plane just medial to the pterygoid hamulus and posterior to the tensor veli palatini tendon (B) the periosteal elevator has bluntly dissected into this plane demonstrating the space and medial mobility that can be generated for the soft palate.
Number of Traditional SLR Patients Requiring VPI Surgery by Age