A Review of Speech Function and Maxillary Growth in Cleft Palate Patients (original) (raw)
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Journal of Cranio-Maxillofacial Surgery, 2015
Objective: To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. Material and methods: A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7e10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. Results: A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. Conclusions: Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.
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.
2021
Introduction: A patient suffering from cleft palate has speech problems even after undergoing surgical procedures to correct it. These problems can be improved by some modality of speech therapy. In this study we aimed to evaluate the outcome of our surgical approach and also the impact of speech therapy on quality of speech in patients who suffered from cleft palate and had undergone surgical correction in Mofid hospital since2011 to 2015. Materials and Methods: We evaluated the quality of speech in the patients suffering cleft palate, older than 3 years who had undergone surgical correction since 2011 to 2015 in our center. Parameters were evaluated in this study included hypernasality, audible nasal emission and disarticulation due to velopharyngeal insufficiency. This process was performed by our center’s speech professionals and informed consent was obtained from the patient's parents. Results: We studied 202 children, 101 males and 101 females. The first surgical procedure...
Journal of Cranio-Maxillofacial Surgery, 2019
The aim of this study was to review the effects of early and late hard palate repair on maxillary growth. PubMed, Scopus, Web of Science, LILACS, Cochrane Library CENTRAL databases, OpenGrey, Google Scholar, and Clinical Trials were searched using a PICO strategy, with terms related to unilateral cleft lip and palate (UCLP) and timing of repair. Methodological quality evaluation was carried out using the Fowkes and Fulton guidelines, and quality (or certainty) of evidence and strength of recommendations were evaluated using GRADE (grading of recommendations, assessment, development and evaluation). Five retrospective and nonrandomized studies were included in the study. Folkes and Fulton assessment showed a high risk of bias in all articles and very low levels of certainty (GRADE). The results showed conflicting findings for comparisons of the effects of timing of repair of hard palate in UCLP. Two studies presented better maxillary growth in a group operated on later (18 months after birth), two presented no differences between the results, and another presented better results in the group operated on earlier than 18 months of age. At this point, it cannot be proven or refuted that postponing hard palate surgery brings benefits for maxillary growth. Studies included in this review did not show similar conclusions. Randomized clinical trials present some ethical issues that make them difficult to perform.
Cleft Palate Speech: Assessment and Intervention
2011
4.1 Introduction ' Despite the relatively long history of palatal surgery, little consensus has been reached regarding the best surgical techniques, and even less regarding optimal timing ' (Peterson-Falzone, Hardin-Jones and Karnell, 2010 , p 149). ' There are still no standard protocols to address the issues of ideal timing for cleft palate repair to attain optimal speech and to avoid abnormal maxillofacial growth after repair ' (Leow and Lo, 2008 , p. 341). The reason for these opinions is that the scientifi c basis for intervention of cleft lip and palate (CLP) is inadequate. The huge diversity of practises is a reality-originally reported in 2000 by Shaw et al. in the survey of European cleft services, where 201 teams reported 194 different surgical protocols for unilateral CLP alone (Shaw et al. , 2000), it is still the position a decade later. Virtually no elements of treatment, that is surgical technique, timing and sequencing, orthodontics and speech therapy, are based on scientifi c evidence (
Limited Chances of Speech Improvement After Late Cleft Palate Repair
Late primary palatal repair is a common phenomenon, and many patients across the world will be operated on at a far later age than is suggested for normal speech development. Nevertheless, little is known about the speech outcomes after these procedures and conflicting results exist among the few studies performed. In this study, blinded preoperative and postoperative speech recordings from 31 patients operated on at Guwahati Comprehensive Cleft Care Center in Assam, India, older than 7 years were evaluated. Six non-Indian speech and language pathologists evaluated hypernasal resonance and articulation, and 4 local laymen evaluated the speech intelligibility/acceptability of the samples. In 25 of 31 cases, the evaluators could not detect any speech improvement in the postoperative recordings. A clear trend of postoperative improvement was only found in 6 of the 31 patients. Among these 6 patients, lesser clefts were overrepresented. Our findings together with previous studies suggest that late palate repairs have the potential to improve speech, but the probability for improvement and degree of improvement is low, especially in older adolescents and adults with complete clefts.