D104. Long-term Outcomes Of A Modified Straight-line Palate Repair Technique: Low Fistula and Speech Correcting Surgery Rates with Single Layer Closure at the Hard-soft Junction

PURPOSE: This study compares fistula and speech correcting surgery outcomes of a modified straight-line repair (SLR) palatoplasty technique to traditional SLR. METHODS: A retrospective chart review evaluated non-syndromic patients with Veau III or IV cleft palate ± cleft lip who underwent SLR palatoplasty from 1993-2023. Patients who underwent modified SLR by the lead author were compared to those undergoing traditional SLR. The modified SLR technique involves cutting the nasal mucosa with aberrant levator muscle insertion off of the hard palate. Primary outcomes included postoperative palatal fistula, fistula location, need for fistula repair, and VPI correcting surgery. Multivariate logistic regression was performed. RESULTS: A total of 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4±5.3 years. Upon multivariate regression, significantly fewer fistulas were observed with modified SLR versus traditional SLR (3.1% vs 15.3%, Odds Ratio OR: 0.19; p=0.001). The modified SLR technique compared to traditional SLR was associated with lower rates of fistula repair surgery (0.6% vs 13.1%, OR: 0.26; p=0.022) and VPI correcting surgery (1.0% vs 16.8%, OR: 0.051; p=0.004). CONCLUSION: The modified SLR technique resulted in fewer fistulas and lower rates of fistula repair surgery and VPI surgery compared to traditional SLR. Release of the nasal mucosa off the hard palate facilitates posterior positioning of the levator muscle, allowing for more medial mobilization of the oral mucosa. This may decrease tension at the hard-soft junction accounting for fewer fistulas.