Articulatory characteristics of cleft palate patients over eight years old after pharyngoplasty with posterior pharyngeal flap

Ruifeng QIN; Kaijin HU; Xinghua FENG; Wei WU

ABSTRACT

BACKGROUND:

According to up-to-date development, the best timing to repair cleft palateis at 9-12 months old after birth when the articulation does not begin to develop.However, there are many over-eight-year-old children who still suffer from unrepaired cleft palate. Therefore, it is veryimportant to adopt proper surgery for these patients to improve palate form and articulatory function.

OBJECTIVE:

To study the characteristics of the cleft palate in patients of over 8 years old and the effects of palate repair and posterior pharyngeal flap transplantation (PPFT) on articulation.

DESIGN:

A controlled study with children patients as subjects.

SETTING:

Department of Maxillofacial Surgery, Medical College of Stomatology, Fourth Military Medical University of Chinese PLA

PARTICIPANTS:

Twenty-four children patients of cleft palate who were treated in the Department of Maxillofacial Surgery ,Medical College of Stomatology, Fourth Military Medical University of Chinese PLA from January 2000 through December 2003 were enrolled in the study. Fourteen were male and ten female. Their ages varied from 8 to 20 years old (mean 13.8 years). Three cases were bilateral complete cleft palate and twelve cases were unilateral complete cleft palate. Nine were incomplete cleft palate.

METHODS:

Two flap palatoplasty and upper pedicle PPFT were conducted in all the patients. In thirty days after surgical treatment, the patients were asked to repeat the words of a doctor in the phonetic lab with his or her lips 10 cm away from microphone. The words of the patients were recorded and evaluated subjectively by 5 doctors specialized in pathologic phones. MAIN OUTCOME

MEASURES:

The palatopharynx was observed with nasopharyngoscope before and after operation. And the improvement of nasal gas leakage and enhanced rhinophonia were also evaluated.

RESULTS:

The repaired cleft palate was healed in the first intention in all the patients. The soft palate retreated satisfactorily and the palatopharynx was apparently closed, which created good preconditions for articulation. The patients' articulation was also improved in different degrees. All the 24 patients had the fourth grade of enhanced rhinophonia and nasal gas leakage before repairing. After palate repair and PPFT, the enhanced rhinophonia and nasal gas leakage of grade 1 was in 3 patients, grade 2 in seven, grade 3 in six and grade 4 in eight patients.

CONCLUSION:

The combination of palate repair and pharyngoplasty is able to improve the form of soft palate and the articulation of over-eightyear-old patients with cleft palate.