Current Advances in Surgical Techniques for Secondary Cleft Palate Repair: A Systematic Review.
Praveen Kumar Chandra Sekar, Ramakrishnan Veerabathiran
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In 30 seconds
This systematic review examined published clinical studies of secondary cleft palate repair in people with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction after primary palatoplasty. Following PRISMA 2021 methods, the authors included 14 studies and qualitatively synthesized outcomes because of heterogeneity. Palate-based re-repair, including Furlow double-opposing Z-plasty and buccal myomucosal flaps, improved resonance and closure in small to moderate gaps; pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but carried greater airway-obstruction risk. Confidence is limited by inconsistent, often non-validated speech assessment methods.
Key findings
- Fourteen studies met the review’s inclusion criteria.
- Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps.
- Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased airway-obstruction risk.
- Most studies lacked validated speech protocols or control for articulatory errors and fistula effects.
Why it matters
Secondary repair aims to address persistent speech and velopharyngeal problems after primary palatoplasty, but outcomes depend on both the procedure and how speech is assessed. The review highlights a trade-off between closure in larger defects and airway-obstruction risk, while showing that inconsistent assessment methods make comparisons and interpretation uncertain.
What to keep in mind
The evidence was heterogeneous and qualitatively synthesized. Most included studies lacked validated speech protocols or control for articulatory errors and fistula effects, limiting confidence in outcome interpretation.