scholarly journals Incidence of Speech-Correcting Surgery in Children With Isolated Cleft Palate

2018 ◽  
Vol 55 (8) ◽  
pp. 1115-1121 ◽  
Author(s):  
Charlotta Gustafsson ◽  
Arja Heliövaara ◽  
Junnu Leikola ◽  
Jorma Rautio
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Fistula Repair ◽  
Repair Rate ◽  
Medical Chart Review ◽  
Before School ◽  
Long Term Observation ◽  
Isolated Cleft Palate

Objective: Speech-correcting surgeries (pharyngoplasty) are performed to correct velopharyngeal insufficiency (VPI). This study aimed to analyze the need for speech-correcting surgery in children with isolated cleft palate (ICP) and to determine differences among cleft extent, gender, and primary technique used. In addition, we assessed the timing and number of secondary procedures performed and the incidence of operated fistulas. Design: Retrospective medical chart review study from hospital archives and electronic records. Participants: These comprised the 423 consecutive nonsyndromic children (157 males and 266 females) with ICP treated at the Cleft Palate and Craniofacial Center of Helsinki University Hospital during 1990 to 2016. Results: The total incidence of VPI surgery was 33.3% and the fistula repair rate, 7.8%. Children with cleft of both the hard and soft palate (n = 300) had a VPI secondary surgery rate of 37.3% (fistula repair rate 10.7%), whereas children with only cleft of the soft palate (n = 123) had a corresponding rate of 23.6% (fistula repair rate 0.8%). Gender and primary palatoplasty technique were not considered significant factors in need for VPI surgery. The majority of VPI surgeries were performed before school age. One fifth of patients receiving speech-correcting surgery had more than one subsequent procedure. Conclusion: The need for speech-correcting surgery and fistula repair was related to the severity of the cleft. Although the majority of the corrective surgeries were done before the age of 7 years, a considerable number were performed at a later stage, necessitating long-term observation.

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

2002 ◽  
Vol 39 (4) ◽  
pp. 397-408 ◽  
Author(s):  
Christina Persson ◽  
Anna Elander ◽  
Anette Lohmander-Agerskov ◽  
Ewa Söderpalm
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Reference Group ◽  
University Hospital ◽  
Perceptual Judgment ◽  
Cross Sectional ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate ◽  
The Impact

Objective The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. Design A cross-sectional retrospective study. Setting A university hospital serving a population of 1.5 million inhabitants. Subjects Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. Interventions A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Main outcome Measures Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. Results The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. Conclusion Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Speech in Children with an Isolated Cleft Palate: A Longitudinal Perspective

2006 ◽  
Vol 43 (3) ◽  
pp. 295-309 ◽  
Author(s):  
Christina Persson ◽  
Anette Lohmander ◽  
Anna Elander
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Intervention ◽  
University Hospital ◽  
Speech Sounds ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate

Objective To describe articulation and speech symptoms related to velopharyngeal impairment in children born with an isolated cleft palate. Design Blind assessment of speech at 3, 5, 7, and 10 years of age was performed. Two subgroups were formed based on the results at age 5 years, the no-VPI group and the VPI group, and they were compared with controls. Setting A university hospital. Patients Twenty-six children born with isolated cleft palate. Seventeen children served as controls. Interventions Soft palate closure at 7 months and hard palate closure at a mean age of 3 years and 11 months if the cleft extended into the hard palate. Main Outcome Measures Perceptual assessments of four variables related to velopharyngeal function and of articulation errors were performed at all ages. Phonetic transcriptions of target speech sounds were obtained at 5, 7, and 10 years and nasalance scores were obtained at age 10 years. Results The no-VPI group continued to have no or minor difficulties. The VPI group improved but continued to have moderate velopharyngeal impairment. Both groups differed significantly from the controls at age 10 years. Persistent velopharyngeal impairment, as well as glottal misarticulation, were mostly found in children with the cleft as a part of a syndrome or together with multiple malformations. Conclusion Small changes in velopharyngeal impairment were found across ages. Improvement seemed to be related to surgical intervention, and persistent problems seemed to be related to the presence of additional multiple malformations or syndromes.

Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair

2021 ◽  
pp. 105566562110295
Author(s):  
Åsa C. Okhiria ◽  
Fatemeh Jabbari ◽  
Malin M. Hakelius ◽  
Monica M. Blom Johansson ◽  
Daniel J. Nowinski
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
The Impact ◽  
Nasal Emission

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

The Correlation between Nasalance and a Differentiated Perceptual Rating of Speech in Dutch Patients with Velopharyngeal Insufficiency

2002 ◽  
Vol 39 (3) ◽  
pp. 277-284 ◽  
Author(s):  
Kornelis H.D.M. Keuning ◽  
George H. Wieneke ◽  
Hans A. Van Wijngaarden ◽  
Philippe H. Dejonckere
Keyword(s):  
Cleft Palate ◽  
Correlation Coefficients ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Visual Analog Scales ◽  
Cleft Palate Speech ◽  
Normal Text ◽  
The Mean ◽  
Lower Correlation ◽  
Nasal Emission

Objective: The correlation between the nasalance score and the perceptual rating of several aspects of speech of speakers with velopharyngeal insufficiency (VPI) by six speech-language pathologists was evaluated. Procedure: The overall grade of severity, hypernasality, audible nasal emission, misarticulations, and intelligibility were rated on visual analog scales. Speech samples with a normal distribution of phonemes (normal text [NT]) and those free of nasal consonants (denasal text [DT]) of 43 patients with VPI were used. Mean nasalance scores were computed for the speech samples, and Spearman correlation coefficients were computed between the mean nasalance score and the five parameters of the differentiated rating. Setting: The Institute of Phoniatrics, Utrecht University Hospital, The Netherlands. Results: The correlation coefficient between the mean nasalance and the perceptual rating of hypernasality ranged among judges from .31 to .56 for NT speech samples and .36 to .60 for DT speech samples. Only small differences were found between speech pathologists with and without expertise in cleft palate speech. The rating of the overall grade of severity appeared to correlate quite well with the rating of the intelligibility (rNT = .77, rDT = .79). Lower correlation coefficients, ranging from .34 to .71, were found between overall grade of severity and hypernasality, audible nasal emission, and mis-articulations. Conclusions: A low correlation between the nasalance and the perceptual rating of hypernasality was found. The parameter overall grade of severity appeared to be determined mainly by the parameter intelligibility. Expertise in rating of cleft palate speech does not guarantee a high correlation between instrumental measurement and perceptual rating.

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

Unilateral Absence of the Soft Palate: Case Report of Reconstruction with a Mucoperiosteal Island Flap

1993 ◽  
Vol 30 (5) ◽  
pp. 497-499 ◽  
Author(s):  
M. Emin Mavili ◽  
Tacettin Gucer ◽  
Yucel Erk
Keyword(s):  
Case Report ◽  
Cleft Palate ◽  
Soft Palate ◽  
Speech Quality ◽  
Island Flap ◽  
Velopharyngeal Insufficiency ◽  
Congenital Absence

Congenital absence of half of the soft palate Is a rare deformity. There is little in the literature about its definition and management. This article presents a case with velopharyngeal insufficiency caused by unilateral absence of the soft palate. The patient was treated with a modification of the mucoperiosteal Island flap, first designed by Millard, to provide nasal lining during pushback lengthening of a short cleft palate. The speech quality of the patient Improved noticeably after the operation. Although island flap has limited use in primary cleft palate surgery, It may be effective in reconstruction of soft palate defects, when standard pushback procedures are not adequate for solving the problem.

Morphological Characterization of the Levator Veli Palatini Muscle in Children Born with Cleft Palates

2001 ◽  
Vol 38 (5) ◽  
pp. 438-448 ◽  
Author(s):  
Rolf Lindman ◽  
Gunnar Paulin ◽  
Per S. Stål
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Repair ◽  
Fiber Type ◽  
Muscle Spindles ◽  
Morphological Characterization ◽  
Velopharyngeal Insufficiency ◽  
Normal Adult ◽  
Levator Veli Palatini

Objective: The aim of this study was to analyze, morphologically and biochemically, one of the soft palate muscles, the levator veli palatini (LVP), in children born with cleft palate. Subjects and Methods: Biopsies were obtained from nine male and three female infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for comparison. The muscle morphology, fiber type and myosin heavy chain (MyHC) compositions, capillary supply, and content of muscle spindles were analyzed with different enzyme-histochemical, immunohistochemical, and biochemical techniques. Results: Compared with the normal adult subjects, the LVP muscle from the infantile subjects with cleft had a smaller mean fiber diameter, a larger variability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infantile subjects with cleft LVP either lacked muscle tissue or contained only a small amount. Conclusions: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might be related to different stages in maturation of the muscles, changes in functional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue in some of the cleft biopsies offers one possible explanation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.

Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate—a cephalometric study at 5 and 10 years

2018 ◽  
Vol 41 (4) ◽  
pp. 420-427 ◽  
Author(s):  
Konstantinos Parikakis ◽  
Ola Larson ◽  
Agneta Karsten
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Mixed Model ◽  
Craniofacial Morphology ◽  
Consecutive Series ◽  
Face Height ◽  
Minimal Incision ◽  
Lateral Cephalograms ◽  
Upper Face ◽  
Isolated Cleft Palate

Summary Objective To compare differences in facial growth in patients with isolated clefts of the hard and/or soft palate treated with the minimal incision technique without (MI) or with muscle reconstruction (MMI). Subjects and method A consecutive series of 170 Caucasian children born with isolated cleft palate were studied. Individuals with other craniofacial malformations, apart from Pierre Robin sequence (PRS), were excluded. The patients were treated surgically with MI (n = 85) or MMI (n = 85) palatoplasty (mean age: 13 months) and divided further into two subgroups: clefts within the soft palate only (small cleft, n = 51) and within the hard and soft palate (big cleft, n = 119). A retrospective evaluation at 5 (mean 5.4) and 10 (mean 10.3) years was performed using lateral cephalograms. Twelve skeletal and one soft tissue measurement was evaluated. Both 95% and 99% confidence intervals were calculated, two-way ANOVA and mixed model analysis was performed including/excluding PRS. Results At 5 years, statistically significant increased inclination of the palatal plane in the big MMI cleft group (P < 0.01), increased posterior upper face height (P < 0.01), and longer mandibular length (P < 0.001) in the small MI cleft group was observed. At 10 years, statistically significant increased inclination of the palatal plane (P < 0.001), decreased posterior upper face height (P < 0.001), and longer palatal length (P < 0.01) was seen in the big MMI group. Limitations Retrospective single centre study, limited sample size, three surgeons. Conclusion Minor differences in craniofacial morphology were found between patients with isolated clefts treated with MI or MMI technique and between small and big cleft lengths.

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.

Retrospective Evaluation of Craniofacial Growth of Japanese Children with Isolated Cleft Palate: From Palatoplasty to Adolescence

2005 ◽  
Vol 42 (6) ◽  
pp. 625-632 ◽  
Author(s):  
Sayaka Fujita ◽  
Akira Suzuki ◽  
Norifumi Nakamura ◽  
Masaaki Sasaguri ◽  
Yasutaka Kubota ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Craniofacial Morphology ◽  
University Hospital ◽  
Vertical Position ◽  
Craniofacial Growth ◽  
Facial Height ◽  
Anterior Cranial Base ◽  
Normal Occlusion ◽  
Isolated Cleft Palate ◽  
Remarkable Deviation

Objectives The purposes of this study were to analyze the craniofacial growth in women with an isolated cleft palate, to compare their matured craniofacial form with that of women with normal occlusion, and to survey the factors that influenced the matured craniofacial morphology of the adults with cleft palate during their growth process. Materials and Methods Eighteen women with nonsyndromic isolated cleft palate were chosen from patients who received a palatoplasty at the Kyushu University Hospital, Fukuoka, Japan. Their lateral cephalometric radiographs were taken longitudinally from palatoplasty to adolescence. Fifty women with normal occlusion were chosen as controls. From their lateral cephalographs, linear and angular variables were calculated using the x,y coordinates of 20 skeletal landmarks. Results Maxillary length was shorter and the nasomaxillary complex was positioned more posteriorly in relation to the anterior cranial base of the adults with isolated cleft palate, compared with the controls. The mandible was shorter and was rotated inferiorly and posteriorly. However, remarkable deviation from the average craniofacial growth pattern was not recognized from palatoplasty to adolescence. The factors that influenced the craniofacial growth in the subjects with cleft palate were the forward growth of the A point from 2 to 5 years of age, the downward growth of the Ba point, the anterior upper facial height N-Ans in puberty, and the vertical position of the point Ba at the time of palatoplasty. Conclusion This study provided evidence of the growth tendency and the factors influencing the intermaxillary relationship in subjects with isolated cleft palate. These are significant for orthodontic treatment planning.

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