Uvular transposition: A new method of cleft palate repair

This prospective study was done to determine whether a new cleft palate rep air utilizing uvular transposition improved speech outcome as measured obje ctively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvula by a double-opposing Z-pl asty; an intravelar veloplasty was performed, and two-thirds of the mass of the uvula was transposed to the nasal surface of the soft palate. This pro cedure facilitates velopharyngeal closure by significantly lengthening the palate, anatomically reconstructing the muscles of the palate, and decreasi ng the palatal excursion necessary to achieve closure. Sixty-two children with a cleft palate were treated with this procedure per formed by the senior surgeon between the years of 1988 and 1995. These chil dren were then enrolled in cleft lip and palate clinic at age 2 to 3 years and blindly evaluated yearly by a single speech pathologist who specialized in pediatric speech pathology. Postoperative clinical follow-up ranged fro m 36 to 112 months (mean, 56.8 months). Perceptual nasal emission was found to be normal in 59 of the 62 patients ( 95 percent). Nasometry was performed in all 62 of these patients, and the m ean score was 15.7 percent, well within the accepted normal range of 25 or less at our institution. Only two of these children (3 percent) required a pharyngeal flap for velopharyngeal insufficiency. These findings suggest that the uvula transposition cleft palate repair may result in good normalization of speech with negligible rates of velopharyn geal insufficiency.