The Most Efficient Surgical Technique to Treat Velopharyngeal Insufficiency After Primary Cleft Palate Repair: A Systematic Review and Meta-Analysis.
Amirhossein Fasahat, Mohammad Omid, Fatemeh Khanlar et al.
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In 30 seconds
This systematic review and meta-analysis compared five surgical techniques for velopharyngeal insufficiency after primary cleft palate repair, using improvement in hypernasality as the outcome. It included 1774 patients from 31 studies; syndromic patients and studies without original data were excluded. Furlow palatoplasty had the highest average improvement rate at 85.06%, closely followed by pharyngeal flap at 84.50%. Heterogeneity was high across most technique groups, and complication profiles varied, with some studies reporting more obstructive sleep apnea after pharyngeal flap.
Key findings
- Average hypernasality improvement was 85.06% with Furlow palatoplasty and 84.50% with pharyngeal flap.
- Improvement rates were 83.04% for sphincter pharyngoplasty, 77.61% for buccinator flap, and 59.69% for buccal flap.
- Heterogeneity was high across most surgical groups, with I² up to 100%.
- Complication rates varied; some studies associated pharyngeal flap with higher obstructive sleep apnea rates.
Why it matters
The pooled results suggest that several procedures can improve hypernasality, but the small differences between leading techniques should be interpreted in light of substantial variability among studies and patients. The reported variation in complications, including obstructive sleep apnea in some pharyngeal-flap studies, reinforces the importance of weighing speech outcomes alongside potential harms when considering secondary surgery.
What to keep in mind
High heterogeneity across most groups limits confidence in comparisons between techniques; study designs and patient characteristics varied.