Primary Palatal Surgery in Nonsyndromic Cleft Palate Children and Velopharyngeal Insufficiency Correction Outcomes

2021 ◽  
Vol 32 (2) ◽  
pp. 698-704
Author(s):  
Drina C. Carvajal Álvarez ◽  
Mirta M. Palomares-Aguilera ◽  
María B. Meneses Geldres ◽  
Carlos Villarroel Giugliano
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Palatal Surgery

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.

scholarly journals Nasoendoscopic findings after primary palatal surgery: can the Furlow technique result in a smaller velopharyngeal gap?

CoDAS ◽  
2015 ◽  
Vol 27 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Gabriela Zuin Ferreira ◽  
Jeniffer de Cássia Rillo Dutka ◽  
Melina Evangelista Whitaker ◽  
Olivia Mesquita Vieira de Souza ◽  
Viviane Cristina de Castro Marino ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Soft Palate ◽  
Velopharyngeal Insufficiency ◽  
Speech Language Pathologists ◽  
The Difference ◽  
Definition Of ◽  
Palatal Surgery

PURPOSE: To compare the nasoendoscopic findings related to the velopharyngeal gap among patients with cleft palate who underwent the Furlow (F) technique and those who underwent the von Langenbeck (vL) technique for primary palatal surgery, who remained with velopharyngeal insufficiency (VPI).METHODS: The analyzed data were retrieved from the institution's data of recordings of nasoendoscopic exams. The sample comprised 70 recorded nasoendoscopic exams obtained from 22 patients who underwent the F technique and from 48 who underwent the vL technique during primary palatoplasty, who remained with VPI after surgery and were submitted to nasoendoscopy, between the ages of 5 and 15 years (mean age: 8 years), for definition of the best treatment for VPI. The images were edited into a DVD in a randomized sequence to be assessed by three experienced speech language pathologists regarding displacement and excursion of the soft palate; displacement and excursion of lateral pharyngeal's walls; displacement and excursion of the posterior pharyngeal's wall; and presence of the Passavant ridge and size and type of velopharyngeal gap.RESULTS: The results of the comparison of measurements between F and vL groups were not statistically significant.CONCLUSION: The surgical technique used in primary palatoplasty was not relevant to determine the difference in the size of the velopharyngeal gap for patients who maintained VPI.

scholarly journals Clinical Outcomes of Primary Palatal Surgery in Children with Nonsyndromic Cleft Palate with and without Lip

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Seunghee Ha ◽  
Kyung S. Koh ◽  
Heewon Moon ◽  
Seungeun Jung ◽  
Tae Suk Oh
Keyword(s):  
Cleft Palate ◽  
Clinical Outcomes ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Velopharyngeal Insufficiency ◽  
Oronasal Fistula ◽  
Clinical Records ◽  
Palatal Surgery

This study presents clinical outcomes of primary cleft palate surgery, including rate of oronasal fistula development, rate of velopharyngeal insufficiency (VPI) requiring secondary surgery, and speech outcomes. We examined the effect of cleft type on the clinical outcomes. Retrospective analysis was performed using clinical records of all patients who received a primary palatoplasty at the Cleft Palate Clinic at Seoul Asan Medical Center, South Korea, between 2007 and 2012. The study included 292 patients with nonsyndromic overt cleft palate (±cleft lip). The results revealed that the rate of oronasal fistula was 7.9% and the incidence of VPI based on the rate of secondary palatal surgery was 19.2%. The results showed that 50.3% of all the patients had received speech therapy and 28.8% and 51.4% demonstrated significant hypernasality and articulatory deficits, respectively. The results of the rate of VPI and speech outcomes were significantly different in terms of cleft type. Except for the rate of oronasal fistula, patients with cleft palate generally exhibited better clinical outcomes compared to those with bilateral or unilateral cleft lip and palate. This study suggests that several factors, including cleft type, should be identified and comprehensively considered to establish an optimal treatment regimen for patients with cleft palate.

scholarly journals Adenoidectomy for middle ear disease in cleft palate children: a systematic review

2021 ◽  
Author(s):  
Cecilia Rosso ◽  
Antonio Mario Bulfamante ◽  
Carlotta Pipolo ◽  
Emanuela Fuccillo ◽  
Alberto Maccari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Case Series ◽  
Velopharyngeal Insufficiency ◽  
Middle Ear Disease ◽  
Conductive Hearing

Abstract Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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.

Cepstral Analysis of Voice in Children With Velopharyngeal Insufficiency After Cleft Palate Surgery

2014 ◽  
Vol 28 (6) ◽  
pp. 789-792 ◽  
Author(s):  
Zengjie Yang ◽  
Jincai Fan ◽  
Jia Tian ◽  
Liqiang Liu ◽  
Cheng Gan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Cepstral Analysis

Furlow palatoplasty for previously repaired cleft palate with velopharyngeal insufficiency

2015 ◽  
Vol 79 (10) ◽  
pp. 1748-1751 ◽  
Author(s):  
Mosaad Abdel-Aziz ◽  
Ahmed Nassar ◽  
Mohammed Rashed ◽  
Nader Naguib ◽  
Abdel-Rahman El-Tahan
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency

Conversion Furlow Palatoplasty and the Use of Preoperative Video Nasendoscopy

2021 ◽  
pp. 105566562110150
Author(s):  
Alison Kaye ◽  
Meghan Tracy ◽  
Janelle Noel-MacDonnell ◽  
Kathryn Dent
Keyword(s):  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Time To Surgery ◽  
Number Of Children ◽  
Straight Line ◽  
Improved Outcomes ◽  
Additional Surgery ◽  
Significant Difference ◽  
Palatal Surgery ◽  
Line Repair

Objective: To assess outcomes after conversion Furlow palatoplasty with and without routine preoperative flexible fiberoptic video nasendoscopy (FFVN). Design: Retrospective cohort study. Setting: Tertiary Children’s Hospital. Patients: Greater than 3 years of age with cleft palate and velopharyngeal insufficiency (VPI) after straight-line palatoplasty requiring secondary surgery performed with a Furlow palatoplasty. Main Outcome Measures: The number of children with and without routine FFVN prior to conversion Furlow palatoplasty for VPI after initial straight-line palatoplasty. Groups were compared for surgical timing, speech outcomes, and need for additional surgery after conversion Furlow palatoplasty. Results: Fifty-eight patients underwent preoperative FFVN versus 29 without. Mean age at FFVN was 73.8 (SD 34) months. Mean age for secondary palatal surgery by conversion Furlow palatoplasty was 81.5 (SD 34.8) months with FFVN versus 73.4 (SD 34.0) months without FFVN. There was a significant difference ( P < .001) for VPI diagnosis and time to surgery between the groups. Preoperative hypernasality ratings were similar between groups. Postoperatively 65.5% of FFVN and non-FFVN patients corrected to normal resonance. Only 6.9% of all patients rated moderate-severe hypernasality after surgery compared to 42.5% preoperatively. Of total, 5.7% of patients had unchanged hypernasality and only 1 patient rated worse. Seven patients ultimately required additional surgery in attempt to normalize their resonance. Conclusions: Routine preoperative FFVN does not offer any advantage for improved outcomes in children undergoing conversion Furlow palatoplasty after straight-line repair. Routine preoperative FFVN was associated with increased time to surgery after diagnosis of VPI compared to those without FFVN.

Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate

2021 ◽  
pp. 1-18
Author(s):  
Cassandra Alighieri ◽  
Kristiane Van Lierde ◽  
Anne-Sophie De Caesemaeker ◽  
Kris Demuynck ◽  
Laura Bruneel ◽  
...  
Keyword(s):  
Cleft Palate ◽  
High Intensity ◽  
Controlled Trial ◽  
Velopharyngeal Insufficiency ◽  
Dose Frequency ◽  
Baseline Design ◽  
Low Intensity ◽  
Session Duration ◽  
Speech Intervention ◽  
Over Time

Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L ( M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.

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