An Audit of Primary Palatoplasty; Results From One Surgeon and 485 Cases Over 10 Years

Purpose: The purpose of this study is the review of a single surgeon's protocol and experience in primary palatoplasty over a 10 year period at a single cleft centre.

Methods: A retrospective review of a single surgeon's prospectively acquired database was undertaken. The study describes: 1) the demographics of the patient population, 2) the distribution of cleft palate type (Veau and Kernahan & Stark classifications) and cleft severity (palate length and cleft width), and 3) early (fistula rate) and mid-term (rate of secondary surgery for VPI) results. Relationships between the above descriptors and VPI rate were assessed.

Experience: 524 palatoplasties were performed from January 1, 2000 through January 1, 2010. Of these cases, 485 primary palatoplasties were performed. Over this 10 year period, the protocol has been consistent, with two exceptions to be discussed.

Results: There were 276 males and 209 females. The mean age was 20.4 months (range 6.6 months – 17.7 years). Clefts were classified according to Kernahan and Stark (CP=260, CL/P=225) and Veau Class (I=85, II-175, III-165, IV-60). Palate length was assessed according to Randall's classification (I=81, II=319, III=58, IV=2). Palate width, measured on the day of surgery, averaged 7.7 mm (range 0-19 mm). The surgical technique used was dictated by cleft type (Veau classification); 78 Furlow, 101 Veau, 191 von Langenbeck, 114 Clarke, and 1 other. There were 4 fistulas (0.8%). To date 50 patients have undergone secondary procedures for VPI (22 secondary Furlow palatoplasties and 28 pharyngeal flap pharyngoplasties). Significant (p<0.05) predictors of VPI were: male gender, cleft type CL/P (versus CP), short palate length (Randall classification), and increased cleft width.

Conclusions: Demographics, procedures, and results of 485 consecutive palatoplasties are reviewed. The fistula rate is less than 1 percent. The intermediate VPI rate is at least 10 percent. Gender, cleft type, cleft length and cleft width are among predictors for VPI.