Plastic Surgery Research Council
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SUBMUCOUS CLEFT PALATE SPEECH OUTCOMES WORSE THAN CLEFT PALATE ONLY OUTCOMES DESPITE ELIMINATING SYNDROMES A NOVEL COMPARISON GROUP UTILIZING AGE AND ANATOMY MATCHING
Presenter: Alexander Y Lin, MD
Co-Authors: Gildea TH; Shirnov R; Laurent L
Saint Louis University School of Medicine

Background: Increasing evidence suggests submucous cleft palate (SMCP) is not simply a milder form of cleft palate, as some have described worse speech outcomes in SMCP, possibly due to greater syndromic association. Comparing SMCP with other cleft types is confounding, as waiting for clinically detectable velopharyngeal incompetence (VPI) makes SMCP patients older at time of surgery. One approach for a control group is to look at patients with isolated cleft palate only (CPO) who have persistent VPI after their initial primary repair, as the patho-anatomy is analogously a non-clefted palate with VPI.

Methods: Patients who underwent palate or speech surgery from 2004 to 2011 were retrospectively reviewed. All primary SMCP repairs were included. Our age- and anatomy-matched control group (AAMCPO) consisted of patients with CPO undergoing a second speech surgery within the SMCP age range. Postoperative speech was considered successful if the Pittsburgh Weighted Speech Score was less than 2. Comparisons were made with Fisher exact tests.

Results: 21 SMCPs and 26 AAMCPOs met our criteria, with average ages of 5.9 years (range 1.5-10.2) and 5.6 (2.7-10.0), respectively. Proportion of syndromes were: SMCP 9/21 (43%), and AAMCPO 7/26 (27%), P=0.355.

Overall speech success rates were: SMCP 38% (8/21) and AAMCPO 58% (15/26), P=0.244. When patients with syndromes were eliminated, nonsyndromic success rates were: SMCP 8% (1/12) and AAMCPO 58% (11/19), **P=0.008. When only syndromes were compared, success rates were: SMCP 77.8% (7/9) and AACPO 57.1% (4/7), P=0.596.

Conclusion: Even while controlling for age and patho-anatomy, and eliminating syndromic patients, primary SMCP repairs had significantly worse speech outcomes than those in the novel AAMCPO control group undergoing secondary surgery. This is further counterintuitive as primary SMCP repair should have a theoretical advantage, because they lack scar tissue that CPO patients would have after primary palatoplasty. Our data suggests that there are factors other than age and syndromic association that may be affecting speech outcomes in patients with SMCP.


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