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Purpose: Wider cleft palates are thought to be associated with increased complications and poorer outcomes following cleft palate repair. Objective cleft palate photographic measurement and assessment of complications has not been previously performed. The purpose of this study is to quantitatively characterize a series of cleft palate dimensions and to investigate possible correlations with Veau classification and intra-,peri-,and post-operative outcomes.
Methods: The analytic sample included primary cleft palate repairs performed by the senior author over a two-year period. Standard photographs of clefts taken at the time of repair were analyzed using Image-J software. Demographic, intra-operative, peri-operative, and post-operative information was collected. Width measurements were correlated with Veau classification, intra-operative variables, peri-operative variables, and adverse outcomes. Statistical tests performed included simple regression analyses and multiple regression analysis.
Results: Out of 70 patients, 50 had adequate photographic documentation for inclusion in the study. 44% of patients were classified as Veau I with an average cleft width of 5.4 mm, 28% Veau II with an average of 8.9 mm, 16% Veau III with an average of 11.3 mm, and 12% Veau IV with an average of 10.0 mm. No patients exhibited postoperative bleeding, dehiscence, airway problems, infection, fistula formation, or return to the operating room. We found that increasing cleft width significantly predicts increasing Veau classification (p<0.01), increasing operating time (p<0.05), increased hypernasality (p<0.05), and speech delay (p<0.001). Additionally, the presence of an intentional alveolar fistula (Veau III or Veau IV clefts) significantly predicts fluid emission (p<0.001) but cleft width did not predict fluid emission. Increased cleft width did not significantly predict length of stay.
Conclusion: Our data demonstrate that wider pre-operative cleft palates correlate with Veau classification, increased operating time and slightly worsened post-operative sequela. There were no perioperative instances of bleeding, dehiscence, respiratory complications, infection, fistula formation, and return to operating room. Hypernasality and speech delay were associated with increased cleft palate width. Length of stay did not correlate with cleft palate width.