BACKGROUND: Hard palate cleft closure has been associated with maxillary hypoplasia. The Schweckendiek procedure offers delayed hard palate closure to avoid early subperiosteal dissection and palatal scarring. This study sought to compare single-stage versus delayed hard palate closure for speech outcome and maxillary growth. METHODS: A retrospective outcome study was performed of unilateral cleft lip and palate patients with either delayed hard palate repair with a pinned-retained speech prosthesis (Schweckendiek repair) (group 1, delayed hard palate repair, 1978 to 1983) or single-stage cleft palate repair (group 2, single-stage repair, 1983 to 1988). Patients with complete records to maturity at the University of Pittsburgh Cleft Palate Craniofacial Center (n = 82, two equal groups of 41 patients) were studied. Comparative data were collected from multidisciplinary evaluations, perceptual speech scores, speech tests, and cephalometric analysis. RESULTS: Single-stage cleft palate repair had a lower fistulization rate (11 percent) compared with delayed hard palate repair (58 percent). It also had better speech outcomes compared with delayed hard palate repair: mean speech score, 3.1 versus 7.8; final speech score, 0.9 versus 2.9; velopharyngeal incompetency, 21 percent versus 66 percent; failed video fluoroscopy or nasoendoscopy, 18 percent versus 52 percent; and need for secondary speech procedure, 20 percent versus 63 percent. Single-stage repair showed less maxillary growth disturbance, with class III malocclusion, 31 percent versus 66 percent; cephalometric SNA, 78.2 versus 74.8; need for Le Fort I advancement, 24 percent versus 42 percent; and amount of maxillary advancement required, 6 mm versus 9 mm. CONCLUSION: The delayed cleft palate repair led to worse speech outcomes; thus, the authors' center abandoned this technique in favor of single-stage repair. In addition, their data showed that the delayed cleft palate repair led to deleterious maxillary growth.
BACKGROUND:Hard palate cleft closure has been associated with maxillary hypoplasia. The Schweckendiek procedure offers delayed hard palate closure to avoid early subperiosteal dissection and palatal scarring. This study sought to compare single-stage versus delayed hard palate closure for speech outcome and maxillary growth. METHODS: A retrospective outcome study was performed of unilateral cleft lip and palatepatients with either delayed hard palate repair with a pinned-retained speech prosthesis (Schweckendiek repair) (group 1, delayed hard palate repair, 1978 to 1983) or single-stage cleft palate repair (group 2, single-stage repair, 1983 to 1988). Patients with complete records to maturity at the University of Pittsburgh Cleft Palate Craniofacial Center (n = 82, two equal groups of 41 patients) were studied. Comparative data were collected from multidisciplinary evaluations, perceptual speech scores, speech tests, and cephalometric analysis. RESULTS: Single-stage cleft palate repair had a lower fistulization rate (11 percent) compared with delayed hard palate repair (58 percent). It also had better speech outcomes compared with delayed hard palate repair: mean speech score, 3.1 versus 7.8; final speech score, 0.9 versus 2.9; velopharyngeal incompetency, 21 percent versus 66 percent; failed video fluoroscopy or nasoendoscopy, 18 percent versus 52 percent; and need for secondary speech procedure, 20 percent versus 63 percent. Single-stage repair showed less maxillary growth disturbance, with class III malocclusion, 31 percent versus 66 percent; cephalometric SNA, 78.2 versus 74.8; need for Le Fort I advancement, 24 percent versus 42 percent; and amount of maxillary advancement required, 6 mm versus 9 mm. CONCLUSION: The delayed cleft palate repair led to worse speech outcomes; thus, the authors' center abandoned this technique in favor of single-stage repair. In addition, their data showed that the delayed cleft palate repair led to deleterious maxillary growth.
Authors: Elizabeth B Odom; Albert S Woo; Derick A Mendonca; Donald V Huebener; Richard J Nissen; Gary B Skolnick; Kamlesh B Patel Journal: J Craniofac Surg Date: 2016-06 Impact factor: 1.046
Authors: I F P M Kappen; G K P Bittermann; R M Schouten; D Bittermann; E Etty; R Koole; M Kon; A B Mink van der Molen; C C Breugem Journal: Clin Oral Investig Date: 2016-09-16 Impact factor: 3.573
Authors: Michaël Schreurs; C Maarten Suttorp; Henricus A M Mutsaers; Anne Marie Kuijpers-Jagtman; Johannes W Von den Hoff; Edwin M Ongkosuwito; Paola L Carvajal Monroy; Frank A D T G Wagener Journal: Med Res Rev Date: 2019-05-18 Impact factor: 12.944
Authors: Isabelle Francisca Petronella Maria Kappen; Dirk Bittermann; Laura Janssen; Gerhard Koendert Pieter Bittermann; Chantal Boonacker; Sarah Haverkamp; Hester de Wilde; Marise Van Der Heul; Tom Fjmc Specken; Ron Koole; Moshe Kon; Corstiaan Cornelis Breugem; Aebele Barber Mink van der Molen Journal: Arch Plast Surg Date: 2017-05-22
Authors: Hilary McCrary; Sarah Hatch Pollard; Vanessa Torrecillas; Leon Khong; Helene M Taylor; Jeremy Meier; Harlan Muntz; Jonathan Skirko Journal: Cleft Palate Craniofac J Date: 2020-03-24