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Submucous cleft palate.

A report is given of 47 patients with submucous cleft palate operated on during the period 1965 to 1974. The average age of the patients when referred for surgery was high (10.8 years). Eleven patients, or nearly one out of four, had tonsillectomy and/or adenoidectomy performed before the correct diagnosis was made. Sixteen of the patients had a history of recurrent middle ear disease, and 18 patients had another congenital anomaly, the most frequent one being a cleft of the primary palate. Nineteen patients were operated upon with a von Langenbeck palatorraphy, and 28 with a von Langenbeck procedure + a superiorly based pharyngeal flap. Three of the patients were operated on twice. The result with regard to velopharyngeal function was recorded as good in 34 cases, fair in 10, and poor in 3 cases. The results were better in patients operated upon under the age of 7 years. The operative procedures now recommended are: A von Langenbeck (or push-back) closure of the palate combined with a levator sling reconstruction and a superiorly based pharyngeal flap. The possibility for an optimal result is best when the operation is performed at an early age, i.e. as soon as a diagnosis of SMCP and velopharyngeal incompetence has been made. For this reason it is important that better information about the symptoms and signs of SMCP is given to doctors, dentists and speech therapists, who refer these patients to the cleft palate clinic.