A tissue-sparing technique for velopharyngeal sphincter reconstruction in patients with congenital cleft palate

Relevance. Congenital cleft palate (CP) is among the most severe craniofacial malformations. Despite the numerous surgical techniques available, outcomes in affected children remain suboptimal. Postoperative defects may develop
and require additional surgical intervention. Objective. To evaluate and refine a combined technique incorporating palatoplasty, veloplasty, and pharyngoplasty for single-stage reconstruction of the velopharyngeal sphincter. Materials and methods. The study was conducted at the Republican Children’s Multidisciplinary Medical Center in Nukus, Republic of Karakalpakstan, Uzbekistan. A total of 280 patients with cleft lip and palate (CLP) were evaluated, and the findings were compared with the outcomes of previously performed surgical procedures. From this cohort, a subgroup was selected comprising 120 children and 68 adults with cleft palate (CP), 34 patients with CLP, and 18 patients with bilateral cleft lip and palate (BCLP). The 120 children were divided into Group 1 (n = 35) and Group 2 (n = 85). Group 2 comprised 42 patients who had previously undergone cleft lip repair and 43 patients with previously untreated isolated cleft palate. According to the L. E. Frolova classification, 16 clefts were grade IIIa and 17 were grade IIIb. The patients were assessed in collaboration with otorhinolaryngologists to evaluate changes in the dimensions of the nasopharyngeal airway. Results. Review of the patients’ medical histories identified the types of postoperative complications. To narrow the velopharyngeal port, we propose using a pedicled myomucosal flap raised from the lateral pharyngeal wall. The flap mechanically assists soft-palate contraction and elevation, thereby promoting velopharyngeal closure. Conclusion. When veloplasty is performed before cleft lip repair, muscle contraction and scar tension can widen the lip cleft. Early combined cleft lip repair and veloplasty reduces pathological changes in the nasopharyngeal tissues. The proposed technique improves the effectiveness of speech therapy for articulation disorders and shortens the rehabilitation period.

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