Minor modification of soft palate surgical technique resulted in a considerable increase of residual cleft dimensions for unilateral cleft lip and palate.

INTRODUCTION

A two-stage surgical approach, starting with the soft palate, has been practiced in the Gothenburg cleft team for unilateral cleft lip and palate (UCLP) since decades. To improve the velopharyngeal function, a modified soft palate closure (SPC) technique was introduced. Clinical observations did however indicate that the novel technique resulted in a deviant residual cleft shape, potentially contributing to future compromised dental arch form.

AIM: This study aimed to compare residual cleft dimensions (area, width and length) between different SPC techniques and at various age, in individuals born with UCLP.  Material and methods: The sample consisted of three groups of children with non-syndromic UCLP:  1. 27 individuals who had original SPC and hard palate closure (HPC) at 3 years (GBG3) 2. 37 individuals who had a modified SPC and HPC at 2 years (GBGmod)  3. 29 individuals who had original SPC and HPC at 2 years (GBG2).  Residual cleft area, length and width were measured on digitised cast models using Blender software. Multiple linear regression analysis was used to compare the groups.

RESULTS

Larger residual cleft dimensions (area and length) were found for GBGmod compared to both GBG3 (p < 0.001, p = 0.009) and GBG2 (p = 0.009, p = 0.009). In addition, GBGmod had increased cleft width in comparison with GBG3 and GBG2 in quartile 1.

CONCLUSION

The modified SPC technique resulted in larger residual clefts in comparison with the groups operated with the original SPC method. Timing differences between GBG3 and GBG2 are likely one explanation of cleft width variations anteriorly.