{"doi":"10.1597/09-127","title":"Submucous Cleft Palate and Velopharyngeal Insufficiency: Comparison of Speech Outcomes Using Three Operative Techniques by One Surgeon","abstract":"<jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>Our purpose was to compare speech outcomes among three primary procedures for symptomatic submucous cleft palate (SMCP): two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design</jats:title>\n                    <jats:p>Retrospective review.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting</jats:title>\n                    <jats:p>Tertiary hospital.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients, Participants</jats:title>\n                    <jats:p>All children with SMCP treated by the senior author between 1984 and 2008.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions</jats:title>\n                    <jats:p>One of three primary procedures: two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome Measures</jats:title>\n                    <jats:p>Speech outcome and need for a secondary operation were analyzed among procedures. Success was defined as normal or borderline competent velopharyngeal function. Failure was defined as persistent borderline insufficiency or velopharyngeal insufficiency with recommendation for a secondary operation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>We identified 58 patients with SMCP who were treated for velopharyngeal insufficiency. We found significant differences in median age at operation among the procedures ( p &lt; .001). Two-flap palatoplasty with muscular retropositioning (n = 24), double-opposing Z-palatoplasty (n = 19), and pharyngeal flap (n = 15) were performed at a median of 2.5, 3.6, and 9.5 years, respectively. There were significant differences in success among procedures (p = .018). Normal or borderline competent function was achieved in 6/20 (30%) patients who underwent two-flap palatoplasty, 10/15 (67%) following double-opposing Z-palatoplasty, and 11/12 (92%) following pharyngeal flap. Among patients treated with palatoplasty, success was independent of age at operation (p = .16).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Double-opposing Z-palatoplasty is more effective than two-flap palatoplasty with muscular retropositioning. For children older than 4 years, primary pharyngeal flap is also highly successful but equally so as a secondary operation and can be reserved, if necessary, following double-opposing Z-palatoplasty.</jats:p>\n                  </jats:sec>","journal":"The Cleft Palate Craniofacial Journal","year":2011,"id":679402,"datarank":0.6749714505495399,"base_score":4.499809670330265,"endowment":4.499809670330265,"self_citation_contribution":0.6749714505495399,"citation_network_contribution":0.0,"self_endowment_contribution":0.6749714505495399,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":89,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1775096,"name":"Sivabalan Vasudavan","orcid":null,"position":1,"is_corresponding":false},{"id":1775097,"name":"Eileen M. Marrinan","orcid":null,"position":2,"is_corresponding":false},{"id":439156,"name":"John B. Mulliken","orcid":null,"position":3,"is_corresponding":false},{"id":1775095,"name":"Stephen R. Sullivan","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Submucous Cleft Palate and Velopharyngeal Insufficiency: Comparison of Speech Outcomes Using Three Operative Techniques by One Surgeon","abstract":"<jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>Our purpose was to compare speech outcomes among three primary procedures for symptomatic submucous cleft palate (SMCP): two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design</jats:title>\n                    <jats:p>Retrospective review.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting</jats:title>\n                    <jats:p>Tertiary hospital.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients, Participants</jats:title>\n                    <jats:p>All children with SMCP treated by the senior author between 1984 and 2008.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions</jats:title>\n                    <jats:p>One of three primary procedures: two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome Measures</jats:title>\n                    <jats:p>Speech outcome and need for a secondary operation were analyzed among procedures. Success was defined as normal or borderline competent velopharyngeal function. Failure was defined as persistent borderline insufficiency or velopharyngeal insufficiency with recommendation for a secondary operation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>We identified 58 patients with SMCP who were treated for velopharyngeal insufficiency. We found significant differences in median age at operation among the procedures ( p &lt; .001). Two-flap palatoplasty with muscular retropositioning (n = 24), double-opposing Z-palatoplasty (n = 19), and pharyngeal flap (n = 15) were performed at a median of 2.5, 3.6, and 9.5 years, respectively. There were significant differences in success among procedures (p = .018). Normal or borderline competent function was achieved in 6/20 (30%) patients who underwent two-flap palatoplasty, 10/15 (67%) following double-opposing Z-palatoplasty, and 11/12 (92%) following pharyngeal flap. Among patients treated with palatoplasty, success was independent of age at operation (p = .16).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Double-opposing Z-palatoplasty is more effective than two-flap palatoplasty with muscular retropositioning. For children older than 4 years, primary pharyngeal flap is also highly successful but equally so as a secondary operation and can be reserved, if necessary, following double-opposing Z-palatoplasty.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":4.499809670330265,"endowment":4.499809670330265,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"20815725","pmcid":null,"openalex_id":"https://openalex.org/W2114757272","authors":[],"funders":[],"total_grants":0,"fwci":2.2818,"citation_percentile":0.88995922,"influential_citations":0,"citation_trend":[{"year":2012,"count":4},{"year":2013,"count":9},{"year":2014,"count":4},{"year":2015,"count":4},{"year":2016,"count":10},{"year":2017,"count":7},{"year":2018,"count":5},{"year":2019,"count":4},{"year":2020,"count":5},{"year":2021,"count":5},{"year":2022,"count":8},{"year":2023,"count":4},{"year":2024,"count":8},{"year":2025,"count":9},{"year":2026,"count":2}],"oa_status":"closed","license":"https://journals.sagepub.com/page/policies/text-and-data-mining-license","oa_locations":[{"url":"https://journals.sagepub.com/doi/pdf/10.1597/09-127","host_type":"publisher"},{"url":"https://journals.sagepub.com/doi/full-xml/10.1597/09-127","host_type":"publisher"},{"url":"https://doi.org/10.1597/09-127","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/20815725","host_type":"repository"}],"fields_of_study":["Cleft Lip and Palate Research","HIV/AIDS oral health manifestations","Nasal Surgery and Airway Studies"],"mesh_terms":["Child","Child, Preschool","Cleft Palate","Female","Humans","Male","Retrospective Studies","Speech Disorders","Surgical Flaps","Velopharyngeal Insufficiency","Treatment Outcome"],"keywords":["Palatoplasty","Medicine","Velopharyngeal insufficiency","Pharyngeal flap","Surgery","Retrospective cohort study","Dentistry"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-17T13:05:31.930281Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}