Intervention Review

Interventions for the management of submucous cleft palate

  1. Mona Nasser1,*,
  2. Zbys Fedorowicz2,
  3. Tim Newton3,
  4. Mahtab Nouri4

Editorial Group: Cochrane Oral Health Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 6 NOV 2007

DOI: 10.1002/14651858.CD006703.pub2


How to Cite

Nasser M, Fedorowicz Z, Newton T, Nouri M. Interventions for the management of submucous cleft palate. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006703. DOI: 10.1002/14651858.CD006703.pub2.

Author Information

  1. 1

    Institute for Quality and Efficiency in Health care, Department of Health Information, Köln, Germany

  2. 2

    Ministry of Health, Bahrain, UKCC (Bahrain Branch), Awali, Bahrain

  3. 3

    GKT Dental Institute King's College Hospital, Department of Oral Health Services Research & Dental Public Health, London, UK

  4. 4

    Dental School of Shahid Beheshti University of Medical Sciences, Orthodontic Department, Tehran, Iran, Islamic Republic of

*Mona Nasser, Department of Health Information, Institute for Quality and Efficiency in Health care, Dillenburger Street, 27, D-51105, Köln, D-51105, Germany. Monalisa1n@gmail.com. monanasser1@googlemail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the quality and intelligibility of speech. Surgical techniques, which can be used to reconstruct these structural or anatomical defects and to correct velopharyngeal insufficiency, include palatal repair and procedures that rearrange the muscle attachments of the soft palate.

Objectives

To provide reliable evidence regarding the effectiveness of surgical interventions to treat velopharyngeal insufficiency and improve speech in patients with submucous cleft palate.

Search methods

We searched the Cochrane Oral Health Group Trials Register (to 21st December 2006); Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (on 12th March 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (from 1966 to 21st December 2006); EMBASE (from 1980 to 21st December 2006); and CINAHL, ERIC, PsycINFO (on 7th March 2007).

Selection criteria

Randomised controlled trials comparing surgical interventions to correct velopharyngeal insufficiency in submucous cleft palate.

Data collection and analysis

Limited data from one included trial precluded pooling of data, and only a descriptive summary is presented.

Main results

This review included one trial, involving 72 participants aged 4 to 7 years with submucous cleft palate associated velopharyngeal insufficiency, which compared minimal incision palatopharyngoplasty (MIPP) to MIPP with additional velopharyngeal surgery, either pharyngeal flap (32) or sphincter pharyngoplasty (3).
The trial provided no information about post-operative speech assessment, very limited data on any instrumental assessments and there were no reports of obstructive sleep apnoea or other adverse effects after the interventions.
Complete closure occurred in 32 (86%) of the participants in the MIPP group and in 31 (89%) in the additional treatment group, P > 0.05. After eliminating the nine patients with residual velopharyngeal insufficiency, the post-operative gap size during closure was 7.4 ±3.2% in the MIPP group and 8 ±4.1% in the additional intervention group (P > 0.5).

Authors' conclusions

The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty for correcting velopharyngeal insufficiency associated with submucous cleft palate.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for the management of submucous cleft palate

Cleft palate (a split in the roof of the mouth) is a common congenital anomaly which affects approximately 1 in 600 people. Submucous cleft palate (SMCP) is a small subgroup of cleft palate and most of the affected people are asymptomatic. However, some of the individuals with submucous cleft palate have certain speech and resonance problems like hypernasal speech and may undergo surgery.

We found only one study evaluating an uncommon surgical technique called minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty and the trial only provided some weak evidence that these techniques are not significantly different. In addition to this, the trial did not report adverse effects.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

黏膜下顎裂之處理

黏膜下顎裂是一常見的遺傳性發育缺陷.其臨床表現為軟顎之發育不全合併顎咽功能不全,進而影響病患之言語清晰度及言語功能.以手術重建這些結構上或解剖學上的缺陷並矯正顎咽功能異常,包含了顎部修補及軟顎肌肉附著之重建.

目標

針對顎咽功能不全之手術處理的效果,及提升黏膜下顎裂患者之言語功能這方面,試圖提供足夠可信賴之證據以供臨床處理參考.

搜尋策略

我們蒐集了Cochrane Oral Health Group Trials Register(至2006年12月21日);Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (至2007年3月12日);Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4);MEDLINE(從1966年至2006年12月21日);EMBASE(從1980年至2006年12月21日);及CINAHL, ERIC, PsycINFO(於2007年3月7日)

選擇標準

針對矯正黏膜下顎裂及顎咽功能不全之手術處理之隨機臨床試驗.

資料收集與分析

蒐集之隨機臨床試驗之數據有限,只有一敘述性摘要符合.

主要結論

以文獻回顧包含了一隨機臨床試驗,72名黏膜下顎裂合併顎咽功能不全之病人,年齡分佈為4到7歲.比較其手術方式:單純的微創顎咽整形術(minimal incision palatopharyngoplasty)(MIPP),或微創顎咽整形術合併其他顎咽手術包含咽部皮瓣(32)或括約肌咽整形術(3).此一臨床試驗並未針對術後言語功能提出舉證,且無足夠之有效評估.術後並沒有阻塞性睡眠呼吸終止症之個案,也無其他併發症或副作用之案例.在單純的微創顎咽整形術這組中,有32個病人(86%)在術後達到完全閉合,而在微創顎咽整形術合併其他顎咽手術這組中則有31個病人(89%)在術後達到完全閉合, Pvalue大於0.05.去除9名仍有顎咽功能不全之病人後,術後至閉合前之間隙大小為7.4mn及以上;單純的微創顎咽整形術這組中有3.2%.術後至閉合前之間隙大小為8mn及以上;在微創顎咽整形術合併其他顎咽手術這組中. Pvalue大於0.5.

作者結論

此臨床試驗針對兩種矯治黏膜下顎裂合併顎咽功能不全之手術方式的評估都未達到統計上的顯著差異,因此證據有其薄弱及不可靠之疑慮.

翻譯人

本摘要由臺灣大學附設醫院楊方瑜翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

顎裂是一常見的遺傳性發育缺陷,大約每600人中就有1人有此疾病.而黏膜下顎裂是其中一分支,大部分的患者並沒有臨床上的症狀.然而,有部分黏膜下顎裂的患者會有言語或共鳴上的問題,例如發音有過度鼻音,而需要手術介入治療.我們找到一篇臨床試驗報告發表一特殊的手術術式,即微創顎咽整形術(MIPP),或其合併其他顎咽手術包含咽部皮瓣或括約肌咽整形術.然此臨床試驗針對兩種矯治黏膜下顎裂合併顎咽功能不全之手術方式的評估都未達到統計上的顯著差異.同時此研究並未提出此術式所帶來之任何併發症或副作用.