A 25-year review of cases with submucous cleft palate

Objectives: To evaluate the effect of diagnostic and operative time on velopharyngeal closure in submucosal cleft palate (SMCP). Methods: SMCP patients treated at the Keio University School of Medicine from 1986 to 2011 were enrolled as subjects. Clinical data were obtained, including patient sex, age at diagnosis, and operative age, occasion of diagnosis, accompanying deformities, speech test results before and 6 months after palatoplasty, and pharyngeal flap usage after palatoplasty. Results: Data were available for 16 patients, with a mean diagnostic age of 51.1 months (range: 0 - 132 months). The clinical presentations were bifid uvula in 4 patients and speech dysfunction in 11. The cases suspected from bifid uvula were diagnosed significantly earlier than those with speech dysfunction (19.5 versus 56.8 months, p<. 0.01). Velopharyngeal closure was improved in 6 cases, and the average age of these patients at surgery was significantly lower than that of the other patients (46.7 versus 79.8 months, p<. 0.05). A pharyngeal flap was performed in 7 cases (43.8%). The pharyngeal flap usage rate in cleft palate patients other than those with SMCP was significantly lower than that of SMCP patients (3.5% versus 43.8%, p<. 0.01). Conclusions: Early discovery and surgical correction is vital for improving postoperative speech outcomes in SMCP patients. This requires educating physicians about SMCP and future studies regarding simple and effective SMCP screening methods.