Biologic basis of cleft palate and palatal surgery

2020 ◽  
pp. 383-391.e1
Author(s):  
Kevin M. Kelly
Keyword(s):  
Cleft Palate ◽  
Palatal Surgery ◽  
Biologic Basis

scholarly journals Speech in a consecutive series of children born with cleft lip and palate with and without syndromes and/or additional malformations

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristina Klintö ◽  
Maria Sporre ◽  
Magnus Becker
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Consecutive Series ◽  
Total Group ◽  
One Stage ◽  
Audio Recordings ◽  
Bilateral Cleft Lip ◽  
Palatal Surgery ◽  
Group Comparisons

Abstract Background When evaluating speech in children with cleft palate with or without cleft lip (CP/L), children with known syndromes and/or additional malformations (CP/L+) are usually excluded. The aim of this study was to present speech outcome of a consecutive series of 5-year-olds born with CP/L, and to compare speech results of children with CP/L + and children with CP/L without known syndromes and/or additional malformations (CP/L-). Methods One hundred 5-year-olds (20 with CP/L+; 80 with CP/L-) participated. All children were treated with primary palatal surgery in one stage with the same procedure for muscle reconstruction. Three independent judges performed phonetic transcriptions and rated perceived velopharyngeal competence from audio recordings. Based on phonetic transcriptions, percent consonants correct (PCC) and percent non-oral errors were investigated. Group comparisons were performed. Results In the total group, mean PCC was 88.2 and mean percent non-oral errors 1.5. The group with bilateral cleft lip and palate (BCLP) had poorer results on both measures compared to groups with other cleft types. The average results of PCC and percent non-oral errors in the CP/L + group indicated somewhat poorer speech, but no significant differences were observed. In the CP/L + group, 25 % were judged as having incompetent velopharyngeal competence, compared to 15 % in the CP/L- group. Conclusions The results indicated relatively good speech compared to speech of children with CP/L in previous studies. Speech was poorer in many children with more extensive clefts. No significant differences in speech outcomes were observed between CP/L + and CP/L- groups.

Phonetic and Phonologic Skills of Two-Year-Olds with Cleft Palate

1992 ◽  
Vol 29 (5) ◽  
pp. 435-443 ◽  
Author(s):  
Kathy L. Chapman ◽  
Mary A. Hardin
Keyword(s):  
Cleft Palate ◽  
Unstructured Play ◽  
Palatal Surgery

This article examines the phonetic and phonologic skills of 2-year-olds with cleft palate. Fifteen children, 10 children with cleft palate and five noncleft children, participated in the study. The children with cleft palate all received palatal surgery after 12 months of age and after the onset of meaningful speech. All subjects were video and audiotaped while interacting with their mothers during unstructured play. At least one hundred different spontaneous word productions were phonetically transcribed and analyzed for (1) percent consonants correct, (2) phonologic processes, and (3) “compensatory” articulation patterns. A comparison between the groups indicated that although the children with cleft palate exhibited more errors overall, they were similar to their noncleft peers in their phonologic process usage with two exceptions. Additionally, few “compensatory” articulation errors were noted in the speech of these children.

Speech in 5-Year-Olds With Cleft Palate With or Without Cleft Lip Treated With Primary Palatal Surgery With Muscle Reconstruction According to Sommerlad

2018 ◽  
Vol 55 (10) ◽  
pp. 1399-1408 ◽  
Author(s):  
Kristina Klintö ◽  
Evelina Falk ◽  
Sara Wilhelmsson ◽  
Björn Schönmeyr ◽  
Magnus Becker
Keyword(s):  
Cleft Palate ◽  
Normative Data ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Air Leakage ◽  
Fistula Surgery ◽  
Audio Recordings ◽  
Velopharyngeal Function ◽  
Palatal Surgery

Objective: To evaluate speech in 5-year-olds with cleft palate with or without cleft lip (CP±L) treated with primary palatal surgery in 1 stage with muscle reconstruction according to Sommerlad at about 12 months of age. Design: Retrospective study. Setting: Primary care university hospital. Participants: Eight 5-year-olds with cleft soft palate (SP), 22 with cleft soft/hard palate (SHP), 33 with unilateral cleft lip and palate, and 17 with bilateral CLP (BCLP). Main Outcome Measures: Percent oral consonants correct (POCC), percent consonants correct adjusted for age (PCC-A), percent oral errors, percent nonoral errors, and variables related to velopharyngeal function were analyzed from assessments of audio recordings by 3 independent speech-language pathologists. Results: The median POCC was 75.4% (range: 22.7%-98.9%), median PCC-A 96.9% (range: 36.9%-100%), median percent oral errors 3.4% (range: 0%-40.7%), and median percent nonoral errors 0% (range: 0%-20%), with significantly poorer results in children with more extensive clefts. The SP group had significantly less occurrence of audible nasal air leakage than the SHP and the BCLP groups. Before age 5 years, 1.3% of the children underwent fistula surgery and 6.3% secondary speech improving surgery. At age 5 years, 15% of the total group was perceived as having incompetent velopharyngeal function. Conclusions: Speech was poorer in many children with more extensive clefts. Children with CP±L had poorer speech compared to normative data of peers without CP±L, but the results indicated relatively good speech compared to speech of children with CP±L in previous studies.

The Implications of Nasal Substitutions in the Early Phonology of Toddlers With Repaired Cleft Palate

2018 ◽  
Vol 55 (9) ◽  
pp. 1258-1266 ◽  
Author(s):  
Mary A. Hardin-Jones ◽  
Kathy L. Chapman
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Early Sign ◽  
Palatal Surgery

Objective: To examine the implications of nasal substitutions in the early words of toddlers with cleft palate. Design: Retrospective. Patients: Thirty-four toddlers with nonsyndromic cleft palate and 20 noncleft toddlers, followed from ages 13 to 39 months. Main Outcome Measures: The groups were compared for the percentage of toddlers who produced nasal substitutions in their early words. The percentage of toddlers with repaired cleft palate who produced nasal substitutions and were later suspected of having velopharyngeal dysfunction (VPD) was also examined. Results: Seventy-six percent of the toddlers in the cleft group (n = 26) and 35% of toddlers in the noncleft group (n = 7) produced nasal substitutions on one or more of their early words. Only 38% (10/26) of the toddlers with cleft palate who produced nasal substitutions in their early words were later diagnosed as having moderate-severe hypernasality and suspected VPD. Conclusions: The presence of nasal substitutions following palatal surgery was not always an early sign of VPD. These substitutions were present in the early lexicon of children with and without cleft palate.

Timing of Palatal Surgery and Speech Outcome

2008 ◽  
Vol 45 (3) ◽  
pp. 297-308 ◽  
Author(s):  
Kathy L. Chapman ◽  
Mary A. Hardin-Jones ◽  
Jeffrey A. Goldstein ◽  
Kelli Ann Halter ◽  
Robert J. Havlik ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Speech Production ◽  
Group Differences ◽  
Significant Group ◽  
Lexical Status ◽  
Group 2 ◽  
Manner Of Articulation ◽  
The Impact ◽  
Palatal Surgery ◽  
Group 1

Objective: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. Participants: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age  =  11 months) and 20 children (Group 2) were more lexically advanced and older (mean age  =  15 months) when palatal surgery was performed. Main Outcome Measures: Samples of the children's spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each child's connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Group 1 exhibited larger consonant inventories (and true consonant inventories) and more accurate production of nasals and liquids compared to children in Group 2. On the DME task, significant group differences were found for ratings of articulation proficiency and hypernasality. Children in Group 1 exhibited better articulation and less hypernasality than children in Group 2. Conclusions: The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.

scholarly journals The Middle Ear in Cleft Palate Children Pre and Post Palatal Closure

1988 ◽  
Vol 81 (12) ◽  
pp. 710-713 ◽  
Author(s):  
R S Dhillon
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Prospective Trial ◽  
Ventilation Tube ◽  
Long Term Ventilation ◽  
Palatal Surgery

A multicentre prospective trial was commenced in July 1984 to establish the incidence of otitis media with effusion (OME) in children born with a cleft of the palate. Additionally, the data recorded would allow an assessment of the effect of palatal closure on middle ear function. Prior to palatal closure, 97% of ears in a group of 50 patients had otitis media with effusion (OME). The insertion of a long-term ventilation tube provided a means of aeration of one ear with the non-ventilated ear acting as a control. Eighty percent of control ears had persistent OME during a 24-month follow-up period post palatal repair. It would seem that OME is universally present in children with a cleft palate prior to 4 months of age and this incidence is only marginally diminished by palatal surgery. The liaison between plastic surgical and ENT units should be even closer than before in order to manage these patients satisfactorily.

Magnetic Resonance Imaging of the Levator Veli Palatini Muscle before and after Primary Palatoplasty

2004 ◽  
Vol 41 (6) ◽  
pp. 584-592 ◽  
Author(s):  
David P. Kuehn ◽  
Sandra L. Ettema ◽  
Michael S. Goldwasser ◽  
Joseph C. Barkmeier
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cleft Palate ◽  
Imaging Modality ◽  
Magnetic Resonance Images ◽  
Normal Infant ◽  
Resonance Imaging ◽  
Levator Veli Palatini ◽  
Before And After ◽  
Palatal Surgery

Objective To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with cleft palate before and after primary palatoplasty with particular attention focused on the levator veli palatini muscle. Design Prospective study using MRIs of subjects before and after primary cleft palate surgery. Setting Hospital and university based. Patients One female infant with normal anatomy. Three male and four female infants with cleft palate of varying severity. Intervention Furlow double-opposing Z-plasty and V-Y palatoplasty. Main Outcome Measures Magnetic resonance images. Results It was found that the levator veli palatini muscle can be imaged before and after palatal surgery in infants using MRI. The muscle may have sufficient volume, proportionate to a normal infant or adult, in infants born with cleft palate. If retrodisplaced properly, the muscle is likely to be steeper (more vertical) from its origin at the base of the skull to its insertion into the velum following palatoplasty, thus providing a more favorable angle for elevating the velum. Following palatal surgery, the levator muscle mass may not be as cohesive across the velar midline, compared with normal musculature. Conclusion MRI is a viable imaging modality for the evaluation of the anatomy of the levator veli palatini muscle before and after primary palatoplasty in infants born with cleft palate.

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