A Comparison Of Palatoplasty Techniques

Abstract

The efficacy of palate lengthening procedures and intravelar veloplasty performed at the time of primary cleft palate repair was studied in a series of eighty patients by comparing speech results, pressure flow studies, and the ultimate need for pharyngeal flaps. The results indicate that intravelar veloplasty yields better speech through better velopharyngeal function and less frequent pharyn-geal flap procedures. Controversy abounds in cleft surgery, but few procedures generate as much energetic discussion and conflicting reports as does palatoplasty. The von Langenbeck procedure, employing bipedical flaps with no pushback, is the oldest technique still in common use. 1 ts proponents maintain that minimal stripping of the periosteum avoids maxillary hypoplasia (Blocksma et. al. 1975) and speech is as good as with other procedures (Lindsay 1971). Kaplan et. al. (1978) found speech after von Langenbeck palatoplasty to be acceptable, citing only 20% velopharyngeal incompetence. Subsequently , Krause, Tharp, and Morris (1976) in a series of 267 patients from Iowa found this repair gave slightly better speech results than lengthening procedures in soft palate clefts but that V-Y pushback was superior in more extensive clefts. Musgrave et. al. (197 5) also demonstrated superiority of a lengthening procedure. In the midst of this controversy, Braith-waite (1968), Kriens (1969), and Edgerton (1971 and 1969) reported improved speech results by careful dissection and relocation The authors are affiliated with the Division