Interventions for the management of submucous cleft palate

Nasser M, Fedorowicz Z, Newton T, Nouri M

Published Online:

October 8, 2008

Cleft palate (a split in the roof of the mouth) is a common congenital anomaly which affects approximately 1 in 600 people. Submucous cleft palate (SMCP) is a small subgroup of cleft palate and most of the affected people are asymptomatic. However, some of the individuals with submucous cleft palate have certain speech and resonance problems like hypernasal speech and may undergo surgery.

We found only one study evaluating an uncommon surgical technique called minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty and the trial only provided some weak evidence that these techniques are not significantly different. In addition to this, the trial did not report adverse effects.

Abstract (click to read)

Background:

Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the quality and intelligibility of speech. Surgical techniques, which can be used to reconstruct these structural or anatomical defects and to correct velopharyngeal insufficiency, include palatal repair and procedures that rearrange the muscle attachments of the soft palate.

Objectives:

To provide reliable evidence regarding the effectiveness of surgical interventions to treat velopharyngeal insufficiency and improve speech in patients with submucous cleft palate.

Search strategy:

We searched the Cochrane Oral Health Group Trials Register (to 21st December 2006); Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (on 12th March 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (from 1966 to 21st December 2006); EMBASE (from 1980 to 21st December 2006); and CINAHL, ERIC, PsycINFO (on 7th March 2007).

Selection criteria:

Randomised controlled trials comparing surgical interventions to correct velopharyngeal insufficiency in submucous cleft palate.

Data collection and analysis:

Limited data from one included trial precluded pooling of data, and only a descriptive summary is presented.

Main results:

This review included one trial, involving 72 participants aged 4 to 7 years with submucous cleft palate associated velopharyngeal insufficiency, which compared minimal incision palatopharyngoplasty (MIPP) to MIPP with additional velopharyngeal surgery, either pharyngeal flap (32) or sphincter pharyngoplasty (3).
The trial provided no information about post-operative speech assessment, very limited data on any instrumental assessments and there were no reports of obstructive sleep apnoea or other adverse effects after the interventions.
Complete closure occurred in 32 (86%) of the participants in the MIPP group and in 31 (89%) in the additional treatment group, P > 0.05. After eliminating the nine patients with residual velopharyngeal insufficiency, the post-operative gap size during closure was 7.4 ±3.2% in the MIPP group and 8 ±4.1% in the additional intervention group (P > 0.5).

Authors' conclusions:

The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty for correcting velopharyngeal insufficiency associated with submucous cleft palate.

This record should be cited as:

Nasser M, Fedorowicz Z, Newton T, Nouri M. Interventions for the management of submucous cleft palate. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006703. DOI: 10.1002/14651858.CD006703.pub2

Assessed as up to date:

November 7, 2007

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Cleft lip & palate

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for the management of submucous cleft palate

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