Back to 2014 Annual Meeting Abstracts

BACKGROUND:
Palatoplasty is performed to correct velopharyngeal incompetence (VPI). Post-operative palatal fistulas are to be avoided, as these recalcitrant lesions can lead to the regurgitation of fluid and food and independently cause VPI. Post-operative fistula formation is prevented by a tension-free watertight closure. Employing acellular dermal matrix (ADM) in difficult primary palatoplasties has minimized post-operative fistula rates in our previously reported experience. We hypothesize that the incorporation of ADM into primary Furlow palatoplasty does not adversely affect postoperative speech.
METHODS:
A retrospective review of consecutive patients undergoing primary Furlow palatoplasty with or without ADM at a major academic cleft-craniofacial center over a decade (from 2004 - 2013) by a single surgeon was performed. Children with syndromic diagnoses and those unable to cooperate with speech evaluation were excluded. Veau type, demographics, and post-operative speech results [quantified by Pittsburgh Weighted Speech Score (PWSS)] were recorded. The ADM and non-ADM groups were compared with regards to PWSS and frequency of secondary speech surgery (e.g. posterior pharyngeal flap or sphincter pharyngoplasty). Statistical analysis was performed using SPSS Statistics 22.0 (IBM). Nonparametric testing including Mann-Whitney U and Spearman’s rho correlation, Pearson’s Chi-square, and Fisher’s exact testing was utilized where appropriate. Power analysis demonstrated sufficient sample size to demonstrate significant differences if present.
RESULTS:
Inclusion criteria were met by 116 patients (ADM n = 53, non-ADM n = 63). Average follow-up was 5.0 years (range 0.04-9.3 years). ADM use did not differ significantly by gender; 24 females and 29 males received ADM (Pearson Χ2 p=0.802). The cohorts differed with regards to age at time of operation, with an average age of 1.4 ± 0.10 years (mean ± standard error) in the non-ADM group and 1.1 ± 0.04 in the ADM group (Mann-Whitney U Test p=0.036). However, there was no significant correlation between age at time of operation and post-operative PWSS (Spearman’s rho p=0.213). Patients with more severe Veau diagnoses were significantly more likely to be treated with ADM (Pearson Χ2 p<0.001). ADM was utilized in 0 (0%) patients with Veau class 1, 6 (35.3%) patients with Veau class 2, 24 (40.7%) patients with Veau class 3, and 23 (85.2%) patients with Veau class 4. There was no significant correlation between ADM use and subsequent secondary speech surgery: 4 (6.3%) patients in the non-ADM group versus 8 (15.1%) patients in the ADM group (Fisher’s Exact Test p=0.139). There was no significant correlation between ADM use and post-operative PWSS: 3.9 ± 0.69 (mean ± standard error) in the non-ADM group and 5.4 ± 0.97 in the ADM group (Mann-Whitney U Test p=0.334).
CONCLUSIONS:
ADM facilitates effective palatal closure in difficult primary palatoplasties and, as we have previously shown, prevents postoperative fistulas. It would not, however, be acceptable to undermine the primary goal of palatoplasty (normalized speech) to avoid another complication (post-operative fistula). ADM does not appear to adversely affect speech outcomes in primary Furlow palatoplasty. Concerns for possible speech disturbance should not deter one from using ADM to augment potentially tenuous primary Furlow palatoplasties.