Is Pterygoid hamulus fracture a pre requisite for cleft palate surgery? - A Systematic review of surgical, otologic, and speech outcomes.

BACKGROUND

Palatoplasty for cleft palate repair often incorporates adjunctive manoeuvres aimed at achieving tension-free closure. Fracture of the pterygoid hamulus has traditionally been performed for this purpose; however, its necessity and influence on postoperative outcomes remain controversial.

OBJECTIVE

This systematic review aimed to evaluate whether fracture of the pterygoid hamulus during palatoplasty is required and to assess its impact on surgical, otolaryngological, and speech outcomes.

MATERIALS AND

METHODS

A systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science were conducted for studies published between January 2000 and December 2024. Randomized controlled trials, cohort studies, and case-control studies comparing palatoplasty performed with and without pterygoid hamulus fracture were included. Primary outcomes were postoperative hearing and otological status; secondary outcomes included surgical success, complications, and speech outcomes.

RESULTS

Seven studies encompassing 543 patients met the inclusion criteria. Across all included studies, audiological assessments-using brainstem evoked response audiometry, tympanometry, otoacoustic emissions, and otoscopy-demonstrated no statistically significant differences between patients who underwent hamulotomy and those who did not. Surgical outcomes and speech-related measures were also comparable. Minor differences in otoscopic findings were reported in isolated studies; however, these were not supported by corresponding audiometric changes and were considered clinically insignificant.

CONCLUSION

Routine fracture of the pterygoid hamulus during palatoplasty does not confer additional benefit in terms of hearing, surgical success, or speech outcomes. The procedure may be considered selectively in specific cases where additional release is required to achieve tension-free closure, rather than being employed routinely.