Abstract
BACKGROUND: Reported rates of velopharyngeal insufficiency (VPI) after primary palatoplasty for cleft palate (CP) range from 5% to 30%. Although some cases are managed with speech therapy, many patients with VPI require surgical intervention. In this study, we investigate the rate of VPI surgery in patients with CP. METHODS: A systematic review was undertaken following PRISMA guidelines. PubMed, Scopus, and Cochrane databases were used. Studies reporting the rate of VPI surgery in patients with CP were included. Studies containing patients with submucous clefts and/or lacking 6 months follow-up were excluded. Rates of VPI surgery were calculated through weighted means. RESULTS: Fifty-eight articles were included. The overall rate of VPI surgery was 17.5% ± 9.2% (range, 0%-59%). When stratified by phenotype, the rate of VPI surgery was 20.0% ± 13.1% for unilateral cleft lip and palate (range, 0%-39.6%), 27.1% ± 17.2% for bilateral cleft lip and palate (range, 0%-59%), and 14.4% ± 7.2% for isolated CP (range, 0%-47.4%, P > 0.05). When segregated by the palatoplasty technique, the surgical rate was 7.2% ± 3.7% for Furlow, 20.3% ± 19.8% for 2-flap, 5.0% ± 2.8% for Sommerlad, and 23.4% ± 8.0% for 2-stage (P > 0.05). Of studies reporting VPI assessment criteria, speech pathology assessment alone (n = 11, 34.4%) was the most common. CONCLUSIONS: Significant variability exists in reported rates of VPI surgery after CP repair. Initial results suggest a higher rate of VPI surgery in association with certain phenotypes and repair techniques, but data are insufficient for robust conclusions.