Speech outcomes at age 5 and 10 years in unilateral cleft lip and palate after one-stage palatal repair with minimal incision technique - a longitudinal perspective (original) (raw)
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British Journal of Oral and Maxillofacial Surgery, 2013
We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n = 20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n = 20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2017
To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group. Cross-sectional study with long-term follow-up. All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers. Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings. Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one...
The Cleft Palate-Craniofacial Journal, 2012
Objective To investigate long-term, longitudinal speech outcome in patients born with unilateral cleft lip and palate treated according to a two-stage primary palatal protocol with early veloplasty and delayed hard palate closure. Design Retrospective, longitudinal cohort study. Setting A university hospital in western Sweden. Subjects A consecutive series of 55 patients from the total cohort of 65 were included. All patients had surgical procedures at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods Standardized audio recordings were blindly analyzed at 5, 7, 16, and 19 years of age and after at a clinical visit at 10 years of age. Typical cleft speech variables were rated independently on ordinal scales. Intelligibility and perceived velopharyngeal function were assessed also. Prevalences of speech characteristics were determined, and interrater and intrarater agreement were calculated. Results Prominent hypernasality, nasal air leakage, and retracted oral articulation...
Archives of plastic surgery, 2017
No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of...
Journal of Plastic Surgery and Hand Surgery, 2017
Background Clefts of the lip and palate, occurring with an incidence of about 1 per 500 births, are among the commonest birth anomalies affecting humans. The anatomical location of the defect creates problems in feeding, speech, hearing, dental development and facial growth. Communication disability and the distorted facial appearance represent serious barriers to social integration. The success of primary surgery in the early months of life is crucial in determining outcome for the above functions, and the subsequent cost of secondary surgery and remedial care. The scientific basis of the cleft lip and palate discipline is weak since virtually no elements of treatment have been subjected to the rigours of contemporary clinical trial design (Roberts et al., 1991). Thus highly complex and varied protocols of care and a bewildering diversity of surgical technique, timing, and sequencing is practised by teams. Cleft care generally constitutes only a minor part of the clinical load of the disciplines involved-nursing, plastic surgery, maxillofacial surgery, otolaryngology, speech therapy, audiology, counselling psychology, genetics, orthodontics, dentistry. Cleft surgery is almost completely devoid of a sound evidence base. A review of 25 years of the Cleft Palate-Craniofacial Journal identified only 3 randomised control trials, and none of these involved primary surgery (Roberts et al., 1991).
Journal of Clinical Medicine
A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case–control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients ...
Journal of Cranio-Maxillofacial Surgery, 2020
The present study aims to evaluate the effect of timing of cleft palate repair on speech results by using objective assessment tools, under standardized variables. The patients included in the study were divided into three groups according to their age of palatal repair. Velopharyngeal closure was evaluated anatomically by nasopharyngoscopy, and the nasalance values were recorded and evaluated objectively by nasometer. Also, the rate of secondary surgical intervention and fistula rate was analyzed for each group. Nasalance values and nasopharyngoscopic evaluation results were statistically similar between group 1 and group 2. However, there was a statistically significant difference between these groups compared with group 3 in the nasalance value of all speech samples and terms of the velopharyngeal complete closure (p ¼ 0.022). The rate of fistula and secondary surgical intervention was statistically similar between the groups (p ¼ 0.080). In secondary surgical intervention rates, the difference between group 1 and group 3 was statistically significant (p ¼ 0.016). The present study confirms the importance of the 18th month as a cut-of time in palatal repair for improved speech results by using objective assessment tools.
Speech outcome evaluation in post-cleft palate closure patients with two flaps pushback technique
Majalah Kedokteran Gigi Indonesia
Speech quality is an essential output in assessing the success of a palatoplasty. The goal of a palatoplasty is not merely to create a simple anatomical closure of the palate, but also to create an adequate velopharyngeal mechanism for a normal speech outcome and to prevent abnormal maxillofacial development after surgery. The aim of this study is to find out the difference in speech outcome between post-cleft palate closure patients and patients without cleft palate. An analytical retrospective study was conducted on 22 children (n = 22) with complete unilateral cleft palate, who had been treated using two flap push back technic of palatoplasty during 2014-2017 by purposive sampling method, and 22 children without cleft palate as the control group. The evaluation of speech outcome was done using an assessment of perception by doing a speech pathologist and instrumental examination by taking a lateral cephalometry radiograph. The perception was assessed by the articulation pattern, ...
The Cleft Palate-Craniofacial Journal, 2014
Objective To describe and compare speech and phonology at age 3 years in children born with unilateral complete cleft lip and palate treated with three different methods for primary palatal surgery. Design Prospective study. Setting Primary care university hospitals. Participants Twenty-eight Swedish-speaking children born with nonsyndromic unilateral complete cleft lip and palate. Interventions Three methods for primary palatal surgery: two-stage closure with soft palate closure between 3.4 and 6.4 months and hard palate closure at mean age 12.3 months (n = 9) or 36.2 months (n = 9) or one-stage closure at mean age 13.6 months (n = 10). Main Outcome Measures Based on independent judgments performed by two speech-language pathologists from standardized video recordings: percent correct consonants adjusted for age, percent active cleft speech characteristics, total number of phonological processes, number of different phonological processes, hypernasality, and audible nasal air leaka...
Speech Outcome Analysis after Primary Cleft Palate Repair: Interim Siriraj Hospital Audit
Siriraj Medical Journal
Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand.Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist.Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velo...