Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Purpose: Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes. Materials and Methods: A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed. Results: Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-to-Y pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared. Conclusions: The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-to-Y pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings. (C) 2018 The Authors. Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons.