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Factors Affecting Midface Growth After Cleft Palate Closure
Marilyn Ng, MD; Rachel Michael; Ananth S. Murthy, MD
Hospital training program
2015-03-13
Presenter: Marilyn Ng, MD
Affidavit:
Douglas Wagner, MD
Director Name: Douglas Wagner, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
The general incidence of maxillary hypoplasia (MH) is 2%. Palatal scarring after cleft palatoplasty may result in VPI and MH. Cleft patients with MH may require scar release for successful maxillary advancement. The goal of this study was to determine factors associated with MH in isolated cleft palate patients.
Methods:
116 non-syndromic, isolated cleft palate patients underwent palatoplasty between 1972-1995. Retrospective chart review demonstrated an average follow-up of 71.4 months (0-363 months). Variables examined were Veau type, age at closure, closure technique, fistula or VPI, age at and type of VPI operation, number of palatal operations, and MH frequency. Wilcoxon rank sum, Welch T-test, Fisher's exact analyses were performed.
Results:
Median palatoplasty age was 17.4 months. Sixty-four percent were Veau 1 and 36% Veau 2. Fistula and VPI rate was 19% and 31%, respectively. Sixteen percent underwent pharyngoplasty while 84% had a pharyngeal flap. Four patients (3.4%) had MH. All patients underwent 2-flap or Furlow palatoplasty. Age at or technique of palatoplasty and VPI operation were not associated with MH. Presence of fistula (p=0.04), presence of VPI (p=0.03), and cumulative number of (cleft and VPI) procedures (p<0.01) were significantly associated with MH.
Conclusions:
A low MH rate (3.4%) is noted in spite of mucoperiosteal mobilization. Age at and type of palatoplasty were not associated with MH. However, fistula or VPI were associated with MH. We propose that extensive scarring in the hard-soft palate junction from fistula after primary palatoplasty may lead to VPI and MH in the long term.
