Treatment of Submucous Cleft Palate by Pharyngeal Flap as a Primary Procedure

Submucous cleft palate is a type of cleft palate. Its incidence is about 1 in 1200 live births. It is defined by a bifid uvula, muscular diastasis of the soft palate, and notching of the posterior border of the hard palate. Most cases of this condition are asymptomatic but those children are predisposed to velopharyngeal incompetence because of the abnormal musculature of their velopharyngeal sphincter especially if the anatomy of this area was altered by adenoidectomy or even involution of the adenoid pad. For individuals with submucous cleft complaining of velopharyngeal incompetence, the most common treatment is surgical. The surgery consists of reconstruction of the abnormal tissues using palatal repair with or without pharyngeal flap. A primary goal of this surgery is to allow for normal speech production. In this study, 9 cases of symptomatic submucous cleft palate were subjected to treatment by pharyngeal flap only as a primary and single procedure after failure of speech therapy. Flexible nasopharyn- goscopy was carried out for all children to determine the degree of the velopharyngeal gap; the results were recorded on videotape and reviewed in the operating theatre for deter¬mination of the width of the pharyngeal flap. Follow up flexible nasopharyngoscopy showed complete closure of the lateral ports in eight cases (89%) while one case (11%) showed incompetence. Hypernasality was improved in all cases witnessed by parent s questionnaire and this improvement was satisfactory in seven cases (78%) but not satisfactory in two cases (22%). One of the last two cases reached to satisfactory level after speech therapy, while the other case showed no further improvement.