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Cleft Palate Width: Does it correlate with veau classification and outcome?
Roberto Travieso, MD, Robin Wu, BS, Derek M. Steinbacher, MD.
Yale, New Haven, CT, USA.

PURPOSE:
Wider cleft palates are thought to be associated with increased complications and inferior outcomes following repair. Objective cleft palate photographic measurement and assessment of complications has not been previously performed. Our purpose is to quantitatively characterize a series of cleft palate dimensions and to investigate possible correlations with Veau classification and intra-,peri-,and post-operative outcomes. METHODS: Primary cleft palate repairs performed by the senior author over a two-year period were reviewed. Standard photographs taken at the time of repair were analyzed using Image-J software. Width measurements were correlated with Veau classification, intra- and peri-operative variables, and adverse outcomes. Statistical tests performed included simple regression analyses and multiple regression analysis. RESULTS: 50 patients had adequate photographic documentation for inclusion in the study. 44% of patients were classified as Veau I (mean cleft width [MW] 5.4 mm), 28% Veau II (MW 8.9 mm), 16% Veau III (MW 11.3 mm), and 12% Veau IV (MW 10.0 mm). No patients exhibited postoperative bleeding, dehiscence, airway problems, infection, fistula formation, or return to the operating room. We found that increasing cleft width significantly predicts higher Veau classification (p<0.01), increasing operating time (p<0.05), increased hypernasality (p<0.05), and speech delay (p<0.001). The presence of an intentional alveolar fistula (Veau III or Veau IV clefts) significantly predicts fluid emission (p<0.001). Cleft width did not predict fluid emission, or length of stay. CONCLUSION: Our data demonstrate that wider pre-operative cleft palates correlate with higher Veau classification, increased operating time and slightly worsened post-operative sequelae, including hypernasality and speech delay.


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