Classification of SubMucous Cleft Palate and an Algorithm to surgically manage each type accordingly.

SDCC 

Background: No consensus exists on the selection of procedures for the treatment of submucous cleft palate, with scarce reports on long-term outcomes from single-surgeon experience. SubMucous Cleft Palate(SMCP) may be difficult to diagnose at birth, especially in cases of Occult SubMucous Cleft Palate. The SubMucous cleft portion may be limited to soft palate, or extend anteriorly into the posterior half of the hard palate or even up to the anterior half of the hard palate up to the incisive foramen.
Vast majority of individuals with unrepaired submucous cleft palate (SMCP) experience speech difficulties secondary to velopharyngeal insufficiency. There is no classification system to properly describe different types of SubMucous Cleft Palate and as such there is no algorithm available to handle these types of SubMucous Cleft Palate.


Method: We reviewed 127 cases of SMCP operated in the last 8 years at CLAPP Hospital, Lahore Pakistan. Different similar types of SMCP were placed in different groups. Different surgical plans used to operate different SMCP cases were also noted.


Results: We divided the SCMP into 3 main types and then devised an algorithm to manage all these cases accordingly. When the SMCP was limited to Uvula and Soft Palate only, we label it as SMCP1; If the soft palate is of normal or acceptable length, it will be labelled as SMCP1a, however in case the soft palate length is short, then we label it as SMCP1b. Similarly, when SMCP involved Uvula, Soft Palate and posterior half of the hard palate, we label it as SMCP 2; If the soft palate is of normal or acceptable length, it will be labelled as SMCP 2a, however in case the soft palate length is short, then we label it as SMCP 2b. When SMCP involved Uvula, Soft Palate, posterior half of the hard palate and extending into the anterior half of the hard palate, we label it as SMCP 3; If the soft palate is of normal or acceptable length, it will be labelled as SMCP 3a, however in case the soft palate length is short, then we label it as SMCP 3b. We devised an Algorithm to manage all these types of SMCP cases.


Conclusion: Individuals with Non syndromic SMCP present with speech difficulties similar to those experienced by individuals with overt cleft palate. Health care professionals should be aware of diagnosing different types of SMCP and possible presenting symptoms and plan the surgical solutions according to anatomical defects in each type of SMCP.

Craniomaxillofacial/Head and Neck

PSTM 2024