In the normal palate, the muscles of the soft palate (velum) are responsible for closing the velo-pharyngeal opening (the opening between the palate and the pharynx – the back wall of the throat). This is essential for normal speech and to prevent regurgitation of food and fluids through the nose. We know that in the UK, the velopharyngeal opening will not close properly in 25% of patients who have a repaired palate – this is called velopharyngeal insufficiency (VPI). These patients will require further surgery and speech therapy. We estimate approximately 500 palate repairs are carried out in the UK each year so that would mean 125 VPI procedures are required. The figure is probably more because of the back-log of patients who have had less successful repairs in the past.

Until 1990, surgical treatment of VPI involved an operation on the pharynx (a pharygoplasty) to narrow the gap between palate and pharynx. These operations are often successful but have a significant risk of producing obstructive sleep apnoea which can have a very damaging effect on a young child.

Following 20 years of review of patients with VPI and anatomical studies, Brian Sommerlad, current chairman of CLEFT, published in 1994 the first major study on re-repairing the palate and reconstructing the palate muscles in 32 patients as an alternative to pharyngoplasty. A follow-up paper in 2002 on 85 patients further demonstrated the benefits and minimal side-effects of this operation. Also in 1994, Philip Chen from Taiwan published a paper about a different technique for secondary palate surgery using what is described as the double opposing Z-plasty technique on 18 patients.

A recent independent paper published in the American Cleft Palate Craniofacial Journal reviewed the literature on palate re-repair for the treatment of velopharyngeal insufficiency (VPI) and cited the Sommerlad Protocol and Palate Repair technique of VPI as being very beneficial to patients with an 84% success rate. It reported that the 2 papers on the Sommerlad technique were the most scientifically rigorous of the 19 papers reviewed and the only report to use independent speech and language therapists who assessed speech outcomes from randomly mixed recordings.

Of course, it is better if the first palate repair is successful and no further surgery necessary. A recent study, funded by CLEFT, on independently assessed outcomes of the technique of primary palate repair described by Brian Sommerlad and performed by him can be seen at here.

CLEFT is currently looking for funding to research further the function of the muscles of the soft palate in speech and their importance in cleft palate surgery. This study would benefit patients in several ways:

1. Improving the diagnosis of subtle palate abnormalities such as occult submucous cleft palate
2. Refining and improving muscle reconstruction in cleft palate repair through better understanding of their anatomy and function
3. Increasing the value of investigations of velo-pharyngeal function (endoscopy and lateral videofluoroscopy) in patients with velo-pharyngeal incompetence, before and after surgery, and therefore improving diagnosis and patient management
4. Better understanding the role of posterior pharyngeal flap (PPF) and pharyngoplasties in the management of VPI.

This is a three year project working in conjunction with the Clinical Physics Department at Barts and The London Hospital. Much of the preceding work carried out by the North Thames Cleft team on palate function has been in collaboration with this department. CLEFT will provide the anatomical and clinical information for this project and the Clinical Physics Department will provide the expertise in assessment. If you are interested in finding out more about this research or if you would like to make a donation to the research fund, please click here.