Optimal Outcome Reporting 5 and 8 Years Following Cleft Palate Repair

Infographic · Dec 2025 · 1 min read

In brief

Study of 94 cleft palate patients introduces optimal outcome reporting (OOR) metric, measuring normal velopharyngeal function and no fistula after single operation. At 5 and 8 years post-palatoplasty, 69-73% achieved OOR, with younger operative age and nonsyndromic status associated with better outcomes.

Written by the GCMD Library team from the infographic.

The image presents four sequential anatomical diagrams arranged in a 2x2 grid, each showing a sagittal view of the pediatric pelvis and lower gastrointestinal tract. The illustrations use color coding with pink/red tones for healthy tissue and blue/purple shading to indicate aganglionic bowel segments. Surgical steps are depicted with arrows and dotted lines showing tissue manipulation and anastomosis sites.

Balkin, Daniel M. MD, PhD; Incorvia, Joseph MScGH; Reed, Brianna BS; Nuzzi, Laura C. BA; Hughes, Christopher D. MD, MPH; Catallozzi, Liza MS, CCC-SLP; Clark, Roseanne MS, CCC-SLP; Kummer, Ann W. PhD, CCC-SLP, FASHA∥; Meara, John G. MD, DMD, MBA

Background:

No widely applied standardized outcome metric exists following palatoplasty. We created a novel quality metric, optimal outcome reporting (OOR), reflecting patients who experienced the best outcome: normal velopharyngeal function and no unintended fistula after a single operation. We assessed OOR at 5 and 8 years of age in a patient cohort.

Methods:

Data collected included sex, ethnicity, Veau classification, syndromic status, operative age, presence of fistulae, and speech assessments at 5 and 8 years. Patients with submucous clefts were excluded.

Results:

The cohort comprised 94 patients. Median operative age was 10 months; 45% were male, 46% were non-White, and 25% had syndromic diagnoses. The most common cleft types were Veau I (32%) and Veau III (28%). At 5 years, 69% (65 of 94) achieved OOR, with suboptimal outcomes due to multiple operations (9), velopharyngeal insufficiency (19), or fistula (1). At 8 years, 73% (61 of 83) met OOR criteria; failures resulted from multiple operations (12), velopharyngeal insufficiency (9), or fistula (1). Patients with OOR were significantly younger at the time of palate repair. A higher proportion of patients with nonsyndromic diagnoses and those with Veau I/III clefts attained OOR compared with patients with syndromic diagnoses and other cleft types. Nine patients with speech-related suboptimal outcomes at 5 years demonstrated optimal outcomes by 8 years with speech therapy alone.

Conclusions:

Cleft palate OOR describes the ideal outcome following primary palatoplasty. This simple surgical outcome metric can be applied to individual surgeons and across centers, facilitating benchmarking and quality improvement initiatives.

The text in the image