A Review of the Results of Two Different Surgical Procedures for the Repair of Clefts of the Soft Palate Only

Abstract

There is a paucity of data on the relative efficacy of one surgical procedure for the repair of cleft palate over another. Part of the reason for this lack of information lies in the almost insurmountable problems of research design and in the difficulties of generalizing findings from one surgeon to another-However, it may be valuable for the literature to begin to reflect the out. come of various surgical procedures in the hope that cumulative evidence will eventually lend direction in an area Where it is essential. The present study, begun some ten years ago, is an attempt to compare results obtained with simple palatal closure (Von Langenbeck) with those obtained using the V—Y retroposition procedure in children with clefts of the soft palate only. The simple palatal closures utilized lateral relaxing incisions with minimal undermining since all clefts were of the soft palate only. Bony palates were not involved in any clefts in this study. Review of Literature Of these two frequently used methods for primary surgical repair of cleft palate, conclusive superiority of one over the other has not been demonstrated. Von Langenbeck first described his procedure in 1861. The method has been reviewed and supported by Lindsay (6) and is still frequently used. Proponents of the V—Y retroposition approach, Greene (5), Braithwaite (2), Trauner and Trauner (20), Battle (1), Kilner (7), Wardill (21), lVlillard et al. (72), h-TcEvitt (8), and Calnan (3) are numerous; and the procedure is widely used. Grabb (4) comments that the best results appear to be achieved by the V—Y retroposition procedure if one is willing to accept the data reported in the literature from 1948 to 1968. However, Morris (14), in describing pub— lished research reports based on data derived from clinical records, points out that both variability and ambiguity may result when clinical records are used for obtaining study populations and assessing results. Generaliza— tions cannot now be made, he feels, from data collected without consistency and without the rigorous use of pre-selected criteria. For example, since a number of studies (McWilliams (9), Braithwaite (2), and Calnan (3))