The effect of hamulus fracture on the outcome of palatoplasty: A preliminary report of a prospective, alternating study

Objectives To determine whether, in performing palatoplasty, fracture of th e pterygoid hamulus is beneficial, detrimental, or neutral with respect to intraoperative and perioperative complications, hearing outcome, and speech outcome. Designs Prospective, alternating. Setting: Institutional, tertiary deft palate center, Chang Gung Memorial Ho spital, Taipei, Taiwan, Participants: A total of 173 patients enrolled in the study, of whom 161 ha d charts available for analysis. Interventions: During the performance of palatoplasty, 85 patients received hamulus fracture and 76 patients did not, All palatoplasties were performe d by the same surgeon, Main Outcome Measures: (1) Surgical outcomes, including patient demographic data, palatoplasty type and duration, blood loss, incidences of oronasal f istulae, temporary mucosal dehiscence, and postoperative bleeding; (2) otol aryngological outcomes, including hearing results as judged by auditory bra instem response testing, myringotomy tube data describing rates of tube ext rusion, and culture results from sampled effusions; and (3) preliminary spe ech outcomes as described by judgments of overall velopharyngeal function f rom perceptual speech samples. Results: No statistically significant differences in any of the measured su rgical, otolaryngological, or preliminary speech outcomes were found betwee n the groups who did and did not receive hamulus fracture, Conclusions: On the basis of these results, we are unable to advocate the p erformance of hamulus fracture as an operative maneuver during the performa nce of primary palatoplasty. The historical rationale and theoretical advan tage of this maneuver have not been demonstrated here nor have any detrimen tal effects of the maneuver been measured.