0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Association Between Palatal Index and Cleft Palate Repair Outcomes in Patients With Complete Unilateral Cleft Lip and Palate

Percy Rossell-Perry, PhD1,2; Evelyn Caceres Nano, SLP3; Arquímedes M. Gavino-Gutierrez, MD, MSc2,4,5,6
[+] Author Affiliations
1San Martin de Porres University, Lima, Perú
2Outreach Surgical Center, Lima, Perú,
3School of Pedagogic Training of Lima, Lima, Perú
4ReSurge International, Sunnyvale, California
5Universidad Peruana Cayetano Heredia, Lima, Perú
6Asociacion Benefica PRISMA, Lima, Perú
JAMA Facial Plast Surg. 2014;16(3):206-210. doi:10.1001/jamafacial.2013.2537.
Text Size: A A A
Published online

Importance  This study evaluates a technique to estimate cleft severity and tissue hypoplasia in patients with cleft palate. Current classifications are limited to the morphologic characterstics of the clefts. A new classification is proposed in relation to the palatal index, which allows more individualized surgical attention for the cleft palate.

Objective  To evaluate the relationship of palatal index and cleft palate repair surgical outcomes (palatal fistula and velopharyngeal insufficiency) in patients with unilateral cleft lip and palate.

Design, Setting, and Participants  Retrospective study performed by the Outreach Surgical Center Program Lima, Lima, Perú, of surgical outcomes of 152 consecutive pediatric patients, aged 12 to 15 months, with nonsyndromic unilateral complete cleft lip and palate treated during from 2001 to 2007. Findings were obtained at 1 to 5 years’ follow-up.

Interventions  Palatoplasty using the 2-flap technique plus intravelar veloplasty. Palate index was measured preoperatively with the patient under general anesthesia.

Main Outcomes and Measures  Postoperative analysis via the χ2 test to assess the statistical significance of association between the palatal index and surgical outcomes.

Results  Palatal fistula rates correlated directly with the cleft severity, as estimated by the palatal index (P = .01), but there was no association between postoperative velopharyngeal insufficiency and palatal index (P = .76).

Conclusions and Relevance  The palatal index was a good predictor of fistula development in the studied group. There was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula. Further long-term study is needed to evaluate the relationship between the palatal index and maxillary growth.

Level of Evidence  4.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Calculating the Palatal Index

The cleft palate was estimated by comparing the cleft’s width (X) with the summed width of both palatal segments (Y1 + Y2), where X represents the cleft width measured in millimeters at the hard palate posterior border level, and Y represents the palatal segment diameter (right and left) measured also in millimeters at the same level as X.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Three Palatal Index Classes of Cleft Palate

A, Mild cleft palate. B, Moderate cleft palate. C, Severe cleft palate.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Complete Cleft Palate, Severe, Palatal Index 0.70

A, Preoperative view showing a 21-mm cleft width and right and left palatal segment widths of 14 and 16 mm, respectively (palatal index, 0.70 [21/30]). B, Postoperative view after repair using the 2-flap technique with raw lateral surfaces.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Complete Cleft Palate, Moderate, Palatal Index 0.38

A, Preoperative view showing a 25-mm cleft width and right and left palatal segment widths of 33 and 32 mm, respectively (palatal index, 0.38 [25/65]). B, Postoperative view after repair using the 2-flap technique without raw lateral surfaces.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();