Effect of Nonradical Intravelar Veloplasty in Patients With Unilateral Cleft Lip and Palate: A Comparative Study and Systematic Review.

BACKGROUND: The purpose of this study was to compare 2 techniques used for primary muscular repair and perform a systematic review of the literature to evaluate the effects of radical intravelar veloplasty (IVV) on nonsyndromic unilateral cleft lip and palate. METHODS: This is an ambispective study between 2 groups of patients with unilateral cleft lip and palate who were operated using a radical and conservative form of IVV in Lima Peru. Data collection was accomplished by evaluation of speech development and middle ear function of the patients. A systematic review of the literature for studies published until June 2020 to evaluate the effect using the radical IVV in patients with cleft lip and palate. RESULTS: Our comparative study did not find statistically significant differences in speech development between the studied techniques for unilateral cleft palate repair. Increased number of ear tube placements have been observed in the group treated with radical form of IVV. After systematic literature searching, 10 identified studies were qualified for the final analysis, which included 1367 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. CONCLUSIONS: The results arising from this study provides statistical evidence that one technique let us obtain better speech outcomes. A technique with conservative IVV has statistical significant fewer rate of middle ear disorders after primary cleft palate repair. Based on available scientific evidence, definitive conclusions about the effectiveness of radical IVV on velopharyngeal and middle ear function cannot be drawn.

The Lima Surgical Protocol for Cleft Palate Repair.

BACKGROUND: A cleft team experience addressing non-syndromic cleft palate and cleft lip and palate is presented. The purpose of the present study is to compare surgical outcomes using 2 different protocols for cleft palate repair provided by a cleft team in Lima, Perú. METHODS: This is a comparative study between 2 groups of patients with non-syndromic cleft palate who were operated using different surgical protocols from 1999 to 2014. One hundred twenty-four children with non-syndromic isolated cleft palate and cleft lip and palate treated from 2007 to 2014 using a surgical protocol developed by our cleft team in Lima, Perú were compared with 145 children with cleft palate and cleft lip and palate treated by the same team using different protocol from 1999 to 2007. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency (VPI) and postoperative complications. RESULTS: Statistical significant differences were observed between the 2 groups regarding the development of flap necrosis in favor of the Lima protocol. No significant difference in palatal fistula and VPI rate between the 2 protocols was found. CONCLUSIONS: The Lima Surgical Protocol for cleft palate repair is an alternative strategy which uses the strengths of different surgical techniques based on the severity of the cleft. We observed better surgical outcomes using the Lima protocol with regards to postoperative complications in patients with non-syndromic cleft palate.