Hoarseness in Children with Cleft Palate

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P65-P65
Author(s):  
Katherine K Hamming ◽  
Marsha Finkelstein ◽  
James D Sidman
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Rate ◽  
Velopharyngeal Insufficiency ◽  
Additional Risk ◽  
Rate Of Speech ◽  
The Relationship ◽  
Pierre Robin

Objective 1) To determine the rate of hoarseness in children with cleft palate (CP). 2) To understand the relationship between velopharyngeal insufficiency (VPI) and hoarseness in children with CP. Methods Retrospective chart review of 98 patients treated for CP by a tertiary care Children's Hospital Cleft Team and born between 1990 and 2001. Results Of the 98 patients, 59 were male and 39 female. All types of CP were represented. 89% received speech therapy. 41.6% had VPI. The overall rate of hoarseness was 22.4% and of dysphonia was 55.9%. The presence of VPI did not correlate with the presence of hoarseness or dysphonia. However, while VPI decreased when comparing ages 3–4 (58.1%) with ages 6–7 (32.1%) (p <0.001), the hoarseness rates did not change as children got older. Additionally, there was a trend toward higher hoarseness and dysphonia rates in children with Pierre Robin Syndrome (PRS). Conclusions Both VPI and hoarseness are common findings in patients with CP. VPI improves as children get older in the setting of a tertiary care cleft team and a high rate of speech therapy. However, hoarseness and dysphonia do not appear to improve. These findings suggest that the theory that VPI causes hoarseness due to compensatory speech mechanisms may be incorrect. Even when resonance problems have improved, CP patients should continue to be evaluated by speech therapists for voice disturbances, as well as evaluated by otolaryngologists for treatable causes of hoarseness. Further, patients with PRS may be at additional risk for voice disturbances and should be treated accordingly.

Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?

2021 ◽  
pp. 019459982110389
Author(s):  
Sean S. Evans ◽  
Randall A. Bly ◽  
Kaylee Paulsgrove ◽  
Jonathan A. Perkins ◽  
Kathleen Sie
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Speech Errors ◽  
Velopharyngeal Insufficiency ◽  
Predictors Of Success ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Velopharyngeal Function

Objective To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. Study Design Retrospective review of prospectively collected data. Setting Tertiary care children’s hospital. Methods All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). Results In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01). Conclusion VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.

Speech Production of Preschoolers with Cleft Palate

2005 ◽  
Vol 42 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Mary A. Hardin-Jones ◽  
David L. Jones
Keyword(s):  
Cleft Palate ◽  
Significant Relationship ◽  
Speech Therapy ◽  
Velopharyngeal Insufficiency ◽  
Chi Square ◽  
Independent Variables ◽  
Number Of Children ◽  
Dependent Variables ◽  
The Relationship ◽  
Palatal Surgery

Objective The present investigation was conducted to examine the prevalence of preschoolers with cleft palate who require speech therapy, demonstrate significant nasalization of speech, and produce compensatory articulations. The relationship among these three dependent variables and the independent variables of cleft type and age of primary palatal surgery was also examined. Participants The participants included 212 preschoolers with repaired cleft palate aged 2 years 10 months to 5 years 6 months. Main Outcome Measures Chi-square analyses were performed to examine the relationship between two independent variables (cleft type and age of surgery) and three dependent variables (percentage of children requiring speech therapy, percentage demonstrating moderate to severe hypernasality and receiving secondary management for velopharyngeal insufficiency, and percentage producing glottal/pharyngeal substitutions). Results Sixty-eight percent of the children were enrolled in (or had previously received) speech therapy. Thirty-seven percent of the children demonstrated moderate-severe hypernasality or had received secondary surgical management for velopharyngeal insufficiency. Chi-square analyses revealed a significant relationship between cleft type and the number of children referred for speech therapy as well as the number of children with significant hypernasality. The analyses also revealed a significant relationship between age of palatal surgery and number of children with significant hypernasality. Conclusions Despite advances in surgical management and the advantages offered by team care, the majority of preschoolers with cleft palate continue to demonstrate delays in speech sound development that require direct speech therapy. An optimal treatment regimen for these children is one that includes primary palatal surgery no later than 13 months of age.

Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care

2020 ◽  
pp. 105566562095406
Author(s):  
Vanessa Torrecillas ◽  
Sarah Hatch Pollard ◽  
Hilary McCrary ◽  
Helene M. Taylor ◽  
Alexandra Palmer ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Multidisciplinary Team ◽  
Speech Therapy ◽  
Fold Increase ◽  
Velopharyngeal Insufficiency ◽  
Team Care ◽  
Team Assessment ◽  
Hospital Patients ◽  
Cleft Palate Repair ◽  
Or Team

Objective: To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)–approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment. Design: Retrospective cohort setting; tertiary children’s hospital patients; children with cleft palate repair identified through procedure codes. Main Outcome Measures: Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with t test. Multivariate linear and logistic regression adjusted for confounding variables. Results: Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care ( P < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis ( P < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, P < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI ( P < .001) and 20% increased odds of receiving speech surgery ( P < .001). Age at VPI diagnosis and speech surgery were similar between groups ( P = .55 and .29). Discussion: Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated. Conclusion: Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.

Speech Intelligibility of Patients with Cleft Lip and Palate after Placement of Speech Prosthesis

2007 ◽  
Vol 44 (6) ◽  
pp. 635-641 ◽  
Author(s):  
João Henrique Nogueira Pinto ◽  
Giseleda Silva Dalben ◽  
Maria Inês Pegoraro-Krook
Keyword(s):  
Cleft Palate ◽  
Speech Intelligibility ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Velopharyngeal Insufficiency ◽  
Cross Sectional ◽  
Before And After ◽  
Dental Needs

Objective: To evaluate the speech intelligibility of patients with clefts before and after placement of a speech prosthesis. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Brazil. Patients: Twenty-seven patients with unoperated cleft palate or operated cleft palate presenting with velopharyngeal insufficiency (VPI) after primary palatoplasty, treated with speech prosthesis, aged 8 to 63 years. Interventions: Patients were fitted with palatopharyngeal obturators or pharyngeal bulbs, suitable to their dental needs. Five speech-language pathologists blindly evaluated speech samples of the patients with and without the prosthesis. Main Outcome Measures: Classification of speech samples according to a scoring system developed for speech intelligibility problems: 1 (normal), 2 (mild), 3 (mild to moderate), 4 (moderate), 5 (moderate to severe), and 6 (severe). Results were evaluated by the calculation of means of all judges for each patient in both situations. Results: The judges presented significant agreement (W = .789, p < .01). Speech intelligibility was significantly better after placement of the prosthesis for both unoperated patients (Z = 1.93, p = .02) and operated patients with VPI after primary palatoplasty (Z = 1.78, p = .03). Conclusions: Speech intelligibility may be improved by rehabilitation of patients with cleft palate using a speech prosthesis. Speech therapy is needed to eliminate any compensatory articulation productions developed prior to prosthetic management.

Submucous Cleft Palate Repair in Patients With 22q11.2 Deletion Syndrome

2020 ◽  
Vol 58 (1) ◽  
pp. 84-89
Author(s):  
Jenna Fleming ◽  
Noelle Morrell ◽  
Hanan Zavala ◽  
Siva Chinnadurai ◽  
Brianne Barnett Roby
Keyword(s):  
Cleft Palate ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Retrospective Chart Review ◽  
22Q11.2 Deletion Syndrome ◽  
Tertiary Hospital ◽  
Velopharyngeal Insufficiency ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Submucous Cleft Palate

Objective: To determine whether surgical intervention for submucous cleft palate (SMCP) is more common in children with 22q11.2 deletion syndrome (22q DS) compared to children without 22q DS. Design: Retrospective chart review. Setting: Tertiary pediatric hospital and 22q11.2 DS specialty clinic. Participants: One hundred forty-two children seen at the tertiary hospital or clinic during a 20-year period (June 1999-June 2019) with documented SMCP with and without 22q DS. Main Outcome Measure: Percentage of children with SMCP with and without 22q DS requiring surgical intervention for velopharyngeal insufficiency. Results: Patients with 22q DS had a significantly higher frequency of SMCP repair than those without 22q DS (89.7% vs 32.0%, P < .001, χ2 = 37.75). The odds of requiring SMCP repair were 18.6 times higher in those with 22q DS compared to those without (odds ratio = 18.6, CI = 6.1-56.6). Conclusions: This study provides new evidence suggesting patients with 22q DS require SMCP surgical repair for velopharyngeal insufficiency at a significantly higher rate than those without 22q DS. As the majority of patients with 22q DS with SMCP require surgical intervention, future prospective studies looking at early versus late repair of SMCP in patients with 22q DS are needed to guide the surgical repair timeline in this population.

scholarly journals Revision Surgery of the Cleft Palate

2020 ◽  
Vol 34 (02) ◽  
pp. 120-128
Author(s):  
Shirley Hu ◽  
Jared Levinson ◽  
Joseph J. Rousso
Keyword(s):  
Cleft Palate ◽  
Revision Surgery ◽  
Wound Dehiscence ◽  
High Rate ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Primary Surgery ◽  
Common Causes ◽  
Surgical Options ◽  
Surgery Management

AbstractCleft palate repairs often require secondary surgeries and/or revisions for a variety of reasons. The most common causes are symptomatic oronasal fistulas and velopharyngeal insufficiency. Complications from primary surgery, such as wound dehiscence, infection, and hematomas, contribute to the relatively high rate of revision surgery. Prevention of postoperative complications that may lead to fistula or velopharyngeal insufficiency is key, and many techniques have been described that have reportedly decreased the incidence of secondary surgery. Management varies depending on the nature of the fistulous defect and the type of velopharyngeal insufficiency. Numerous surgical options exist to fix this deficiency.

scholarly journals Clinical interventions and speech outcomes for individuals with submucous cleft palate

2020 ◽  
Vol 47 (6) ◽  
pp. 542-550
Author(s):  
Seung Eun Jung ◽  
Seunghee Ha ◽  
Kyung S. Koh ◽  
Tae Suk Oh
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Evaluation Criteria ◽  
Secondary Surgery ◽  
Surgical Interventions ◽  
Delayed Treatment ◽  
End Of Treatment ◽  
Diagnostic Characteristics ◽  
Submucous Cleft Palate ◽  
The Relationship

Background This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement.Methods This retrospective study included 72 children diagnosed with SMCP between 2008 and 2016. The evaluation criteria were the age of the initial visit, total number of visits, age at the end of treatment, speech problems, resonance problems, and speech therapy.Results Children with SMCP first visited the hospital at an average age of 34.32 months, and speech problems were identified at an average age of 48.53 months. Out of 72 children, 46 underwent surgery at an average age of 49.74 months. Four of these children required secondary surgery at an average age of 83.5 months. Among the children who underwent surgery before 3 years of age, 70% exhibited articulation improvements, with mild-to-moderate hypernasality. Articulation improvements showed no statistically significant differences according to age at the time of surgery. However, children who underwent surgery before 4 years had a better hypernasality rating than those who underwent surgery after 4 years of age.Conclusions Children with SMCP tend to undergo delayed treatment because the anatomical symptoms in some children with SMCP are unclear, and surgical interventions are considered only after speech problems are clarified. Starting interventions as early as possible reduces the likelihood of receiving secondary surgery and speech therapy, while increasing expectations for positive speech function at the end.

Obstructive Sleep Apnea and Sleep Position: Does It Matter for Infants With a Cleft Palate?

2018 ◽  
Vol 56 (7) ◽  
pp. 890-895 ◽  
Author(s):  
Christopher J. Greenlee ◽  
Melissa A. Scholes ◽  
Dexiang Gao ◽  
Norman R. Friedman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Sudden Infant Death ◽  
Apnea Hypopnea Index ◽  
Sudden Infant ◽  
Obstructive Sleep

Objective:To determine whether nonsupine sleep improves obstructive sleep apnea (OSA) in infants with cleft palate undergoing polysomnography (PSG).Design:Retrospective chart review.Setting:Tertiary care pediatric hospital.Patients:Twenty-seven infants (1 month to 1 year) with cleft palate with or without cleft lip (CP ± L) undergoing PSG testing for suspected OSA were included.Main Outcome Measures:Polysomnography measures included obstructive apnea–hypopnea index (OAHI), central apnea–hypopnea index (CAHI), oxygen saturation (SpO2) nadir, SpO2, and end-tidal carbon dioxide (ETCO2).Results:Twenty-three PSGs with at least 20 minutes of sleep in both the supine and the nonsupine positions were analyzed. The supine OAHI (mean: 16.8 events/hour; standard deviation [SD]: 18.5) and nonsupine OAHI (mean: 12.6 events/hour; SD: 12.6) did not differ significantly ( P = .10). The supine CAHI (mean: 1.9 events/hour; SD: 2.7) and nonsupine CAHI (mean: 3.1 events/hour; SD: 3.7; P = .15), the supine SpO2nadir (mean: 81.2%; SD: 6.3) and nonsupine SpO2nadir (mean: 81.8%; SD: 5.3; P = .70), the supine mean SpO2(mean: 95.5%; SD: 1.9) and nonsupine mean SpO2saturation (mean: 95.3%; SD: 2.4; P = .34), and the supine ETCO2(mean: 45.4 mm Hg; SD: 5.3) and nonsupine ETCO2(mean: 42.5 mm Hg; SD: 10.1; P = .24) were also similar.Conclusions:There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP ± L. Prior to recommending nonsupine positioning which increases infant’s exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.

Outcomes in Pharyngoplasty: A 10-Year Experience

2006 ◽  
Vol 43 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Landon S. Pryor ◽  
James Lehman ◽  
Michael G. Parker ◽  
Anna Schmidt ◽  
Lynn Fox ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Revisional Surgery ◽  
Retrospective Chart Review ◽  
Surgical Revision ◽  
Velopharyngeal Insufficiency ◽  
Significant Difference ◽  
Potential Risk Factors ◽  
Palate Repair

Objective The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. Design This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. Participants Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. Results Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p > .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. Conclusions Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.

scholarly journals Surgical outcome of two-flap palatoplasty at King Fahad Medical City: A tertiary care center experience

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Alwaleed Khalid Alammar ◽  
Abdulsalam Aljabab ◽  
Gururaj Arakeri
Keyword(s):  
Cleft Palate ◽  
Surgical Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Velopharyngeal Insufficiency ◽  
Reliable Technique ◽  
Significant Relationships ◽  
Speech Therapist ◽  
Nasal Emission

The purpose of this study was to assess surgical outcomes of two-flap palatoplasty for management of cleft palate. Between January 2009 and January 2017, we recruited 29 nonsyndromic patients who underwent two-flap palatoplasty for cleft palate repair at the oral and maxillofacial department. Their medical records were procured, and surgical outcomes were assessed. Velopharyngeal insufficiency (VPI) was evaluated on the basis of speech assessment by a speech therapist. Speech abnormality (nasality, nasal emission, and articulation error) was assessed by a speech therapist using the GOSS-Pass test. Swallowing and regurgitation were assessed by a swallowing team. Fistula and wound dehiscence were clinically assessed by the primary investigator. Documented data were evaluated using statistical analysis. Among the study patients; 75.8 % had normal speech, 20.7 % developed VPI; 17.3% had hypernasality; 4.3% had hypernasality as well as nasal emission; 4.3% had hypernasality, nasal emission, and articulation errors; and 4.3% had articulation errors. Approximately 20% of the patients had fistulas (83.3% had oronasal fistulas and 16.7% had nasovestibular fistulas). Normal swallowing findings were noted in 93% of the patients. There were statistically significant relationships between age-repair and VPI (r=0.450, t=0.014), age-speech (r=0.525, t=0.003), and age-fistula development (r=0.414, t=0.026). Conversely, there were no significant relationships between age and dehiscence (r=0.127, t=0.512), age and swallowing (r=0.360, t=0.055), and age and regurgitation (r=0.306, t=0.106). Two-flap palatoplasty is a reliable technique with excellent surgical and speech outcomes. Early repair is associated with better speech outcome and less incidence of VPI.

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