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A Retrospective Analysis of Speech and Hearing in Patients Receiving Surgery for Submucous Cleft Palate

  • Will Raby-Smith
    Correspondence
    Corresponding author: Will Raby-Smith, Cleft.NET.East, Addenbrooke's Hospital, Cambridge, CB2 0QQ
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
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  • Per Hall
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
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  • Lucy Southby
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
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  • Victoria Parfect
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
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  • Georgina Linford
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
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  • Sam Bannister
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
    Search for articles by this author
  • Kana Miyagi
    Affiliations
    University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

    Cleft.NET.East Regional Cleft Service, Addenbrooke's Hospital, Cambridge, CB2 0QQ
    Search for articles by this author
Published:November 20, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.003

      Abstract

      Submucous cleft palate is an uncommon subtype of cleft palate that is associated with symptoms of velopharyngeal insufficiency, the most common being hypernasal speech. A high proportion of patients also suffer from conductive hearing loss, thought to be due to eustachian tube dysfunction. A number of surgical techniques have been proposed to correct the anatomical defect responsible for velopharyngeal insufficiency. This exploratory study aims to describe surgical techniques and clinical outcomes in a series of patients who underwent surgical repair of submucous cleft palate at a single regional specialist cleft centre between 1999 and 2018. Through a retrospective case-note review, records for 57 patients who underwent SMCP repair between the ages of 6 months and 15 years were examined. Patients underwent one of three surgical techniques: Intravelar Veloplasty, Furlow or a novel technique we have termed “Hemi-Furlow”. Hypernasality, measured on the Great Ormond Street Speech Assessment, showed evidence of improvement post-operatively in all three surgical groups (P<0.005) with no evidence to favour any specific approach. Post-operative complications, including wound dehiscence and fistulae, occurred in nine patients (15.8%). Nine patients (15.8%) required revisional surgery, either due to post-operative complications or persistent speech problems. Otological disease was present in 54.4% of patients, comprising conductive hearing loss due to otitis media with effusion (52.6%) and sensorineural hearing loss (1.8%). There is now a need for large, multi-centre studies with robust outcomes measures to further examine relationships between surgical techniques and clinical outcomes in people born with submucous cleft palate.

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