Complications of Primary Palatoplasty: A Twenty-One Year Review

Abstract

The complications of 196 patients who underwent primary palatoplasties at North Carolina Memorial Hospital between 1963 and 1983 were reviewed. The van Langenbeck technique was utilized in 50 percent of the patients, the Wardill-Kilner technique in 45 percent, and the Dorrance technique in 5 percent. lntravelar veloplasties were performed in 34 percent of the patients. The incidence of postoperative complications was: deaths, 0 percent; malignant hyperthermia, 0 percent ; aborted procedures, 0.5 percent; feeding difficulties, 0.5 percent; aspiration, 0.5 percent; reexploration for bleeding, 0.5 percent; pneumonia , 1 percent; upper respiratory tract infections, 2 percent; postoper-ative airway difficulties, 3 percent; oropharyngeal infections, 4 percent; and otitis media, 10 percent. Later evaluations demonstrated problems with otitis media in 17 percent of the patients and fistulas in 6 percent. An additional palatal operation of some type was later required in 22 percent of the patients, with 18 percent of the patients requiring a pharyngeal flap. lntravelar veloplasties were associated with a decreased incidence of secondary pharyngeal flaps but also an increased transfusion requirement. The Wardill-Kilner technique was associated with a higher incidence of postoperative fistulas, and the use of perioperative antibiotics was associated with fewer postoperative fistulas. KEY WORDS: cleft palate, palatoplasty, complications Cleft palate repair is a commonly performed surgical procedure with a low incidence of surgical complications. Several authors including Musgrave and Bremner (1960) and Wray et a1 (1979) have analyzed the complications associated with cleft palate repairs. The purpose of this study was to review a more recent series of primary palatoplasties and to assess the complications incurred by these patients. Multiple factors were evaluated to determine whether or not they contributed to a higher or lower incidence of complications. These factors were age, sex, Drs. Moore and Ptak are Surgical and Plastic Surgical Resi