Effect of conservative levator veli palatini dissection on palatoplasty: A retrospective cohort study

Cleft palate (CP) is one of the most common facial congenital deformities (Kianifar et al., 2015). CP can result in developmental language disorders, eating disorders, and developmental growth impairment. For these reasons, surgery for CP is important for cosmetic purposes and for solving functional disorders (Lee JS et al., 2015). The typical surgical methods for CP are two-flap palatoplasty and Furlow double-opposing z-plasty. The method used is selected based on the shape and size of the palate and preference of the operating surgeon (Lee JS et al., 2015). Understanding the anatomy of the velar muscle is important when performing CP surgery. Normally, the levator veli palatini (LVP) muscle forms a transverse sling in the posterior half of the soft palate; however, for patients with CP, an abnormal attachment is formed as the LVP is driven longitudinally along the cleft margin due to the cleft. The movement of the soft palate toward the posterior pharyngeal wall is limited due to these deformations, resulting in functional disorders. Therefore, the primary surgical objective is to modify an LVP that is driven longitudinally so that it runs transversely. For proper language development, the soft palate should move backward, upward, and downward, depending on the situation, after the surgery. Most functional problems occur because of the inefficiency of the soft palate's movement; this inefficiency results in velopharyngeal insufficiency and nasal air loss during speech (Pomerantz JH et al., 2017). Given the movement of the soft palate is important in relation to language, and based on the theory that a closed vowel sound test can be used to determine soft palate movement from a linguistic perspective, a study applying a phonological evaluation of the effect of two surgical approaches on soft palate movement was conducted. The study aimed at conservative LVP dissection as an effective method of palatoplasty, in terms of the improvement in linguistic development.

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