Criteria for early and late velopharyngoplasty in 61 children with cleft palate

J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e521-e525. doi: 10.1016/j.jormas.2022.03.003. Epub 2022 Mar 8.


Background: Velopharyngeal insufficiency persists in 15 to 30% of children with cleft palate, despite early velar surgery. Pharyngoplasty using a superior pedicle flap is the most common secondary surgery to treat velopharyngeal insufficiency. This study aims to identify the criteria leading to indicate velopharyngoplasty in 3 groups of age.

Materials and methods: we conducted a retrospective single center study in the reference center for cleft palate in Paris from 2013 to 2016. We included 61 children with non-syndromic cleft operated on with a velopharyngoplasty for velopharyngeal insufficiency. Pre-operative speech and surgical assessments, as well as the operative reports of the children, were analyzed retrospectively using multivariate models.

Results: We included 61 patients. The only criteria factor for an early velopharyngoplasty was the Pittsburgh Weighted Speech Scale (PWSS) score (OR 1.20, CI 95% 1.07 to 1.4 ; P=.006). Criteria for a late velopharyngoplasty were a degradation of the velopharyngeal function (OR 16.07, CI 95% 1.7 to 518.7 ; P=.041) and lost of follow-up (OR 5.78, CI 95% 3.9 to 4320 ; P=.017).

Conclusion: Criteria for early and late velopharyngoplasty were identified, and we demonstrated the insufficiency of Borel-Maisonny classification for scientific clinical study.

Keywords: Cleft palate; Indication criteria; Secondary surgery; Velopharyngeal insufficiency; Velopharyngoplasty.

MeSH terms

  • Child
  • Cleft Palate* / complications
  • Cleft Palate* / diagnosis
  • Cleft Palate* / surgery
  • Humans
  • Pharynx / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Velopharyngeal Insufficiency* / diagnosis
  • Velopharyngeal Insufficiency* / epidemiology
  • Velopharyngeal Insufficiency* / etiology