Two-flap palatoplasty: 20-year experience and evolution of surgical technique

Background: The two-flap palatoplast was described more than 30 ears ago, but there are few reports of long-term results using this technique. There are also very few long-term series of a single method of palatoplasty from a single surgeon. Methods: The authors reviewed the technique of the two-flap palatoplasty, with emphasis on the senior author's (K.E.S.) modifications. The authors also retrospectively reviewed 382 two-flap palatoplasties performed by the senior author in nonsyndromic patients over a 20-year period. The incidence of secondary velopharyngeal surgery was established. Detailed speech analysis was performed in a subset of 150 patients. Results: The proportion of patients with velopharyngeal insufficiency over 20 years was 8.92 percent, falling from 10.95 percent in the first decade to 6.43 percent in the second decade. There was no significant difference in velopharyngeal insufficiency between the cleft subtypes. Age at palatoplasty did not affect the development of velopharyngeal insufficiency, but it should be noted that most of the patients underwent palate repair before 12 months of age. Speech results were consistently good across the two decades. In the second decade, 91.14 percent had normal to mildly impaired resonance, 79.75 percent had no or inaudible nasal air emission, and 97.47 percent demonstrated no compensatory articulation errors. Conclusions: The two-flap palatoplasty is a reliable technique that has yielded excellent surgical and speech outcomes. Early and regular speech assessments and appropriate treatment when indicated are an integral part of the multidisciplinary approach to achieve good speech outcome.