Submucous Cleft Palate: A Grading System and Review of 40 Consecutive Submucous Cleft Palate Repairs

Objective This study was designed to determine whether velar surgery was worthwhile for submucous cleft palate (SMCP) and evaluate whether results were dependent on the degree of the anatomical abnormality. Design A prospective study of a consecutive series of patients fulfilling the entry criteria, assessed blindly from records arranged randomly. Patients Fifty-eight patients diagnosed with SMCP and operated on by a single surgeon between June 1991 and April 1997 were reviewed. Forty patients fulfilled the entry criteria. Minimum follow-up was 6 years. Interventions Radical reconstruction of the soft palate musculature was performed by one surgeon using the operating microscope. A scoring system was devised for grading the anatomical severity of submucous cleft (SMCP score). Main Outcome Measures Postoperative hypernasality and nasal emission scores and the degrees of improvement were considered the primary outcome measures, and the degree of velopharyngeal closure was also assessed. Results There were highly significant improvements in hypernasality, nasal emission, and velopharyngeal closure. A preoperative gap size of more than 13 mm was associated with less satisfactory outcomes, but gap size was not predictive of improvement. Severity of the SMCP did not correlate with the degree of preoperative speech abnormality but was a significant predictor of outcome of surgery, with the less severe (total SMCP score of 0 to 3) having less satisfactory end results and lesser degrees of improvement. Patients with less abnormal muscle anatomy had lesser degrees of improvement. Conclusion Repair of the muscle abnormality in SMCP is recommended as the first line of treatment in most cases.

Download Full-text

Speech Outcome and Velopharyngeal Function in Cleft Palate: Comparison of Le Fort I Maxillary Osteotomy and Distraction Osteogenesis—Early Results

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-003 ◽

2007 ◽

Vol 44 (1) ◽

pp. 23-32 ◽

Cited By ~ 40

Author(s):

Nattharee Chanchareonsook ◽

Tara L. Whitehill ◽

Nabil Samman

Keyword(s):

Cleft Palate ◽

Outcome Measures ◽

Gap Size ◽

Le Fort I Osteotomy ◽

Chi Square ◽

Le Fort ◽

Le Fort I ◽

Nasal Emission ◽

Maxillary Distraction

Objective: To compare speech outcome and velopharyngeal (VP) status of subjects with repaired cleft palate who underwent either conventional Le Fort I osteotomy or maxillary distraction osteogenesis to correct maxillary hypoplasia. Design: Prospective randomized study with blind assessment of speech outcome and VP status. Subjects: Twenty-two subjects were randomized into conventional Le Fort I osteotomy and Le Fort I distraction groups. All were native Chinese (Cantonese) speakers. Method: Perceptual judgment of resonance and nasal emission, study of VP structures by nasoendoscopy, and instrumental measurement by nasometry. Assessments were performed preoperatively and at 3 months postoperatively. Main Outcome Measures: Assessment of VP closure, perceptual rating of hypernasality and nasal emission, nasalance, and amount of maxillary advancement. Results: There was no statistical difference in any of the outcome measures between the 10 subjects with conventional Le Fort I osteotomy and the 12 subjects with maxillary distraction: hypernasality (chi-square = 3.850, p = 0.221), nasal emission (chi-square = 0.687, p = 0.774), VP gap size (chi-square = 1.527, p = 0.635, and nasalance (t = −0.145, p = 0.886). There was no correlation between amount of maxillary advancement and any of the outcome measures (p = .05 for all). Changes in VP gap size and resonance are described. Conclusion: Results need to be interpreted with caution because of the small sample size and early follow-up. However, this study utilized an assessment protocol involving a variety of outcome measures and careful consideration of reliability factors, which can be a model for further and follow-up studies.

Download Full-text

Phonological Profile of Patients With Velopharyngeal Dysfunction and Palatal Anomalies

Journal of Speech Language and Hearing Research ◽

10.1044/2021_jslhr-20-00652 ◽

2021 ◽

pp. 1-15

Author(s):

Ariela Nachmani ◽

Muhamed Masalha ◽

Firas Kassem

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Age Groups ◽

Phonological Process ◽

Phonological Processes ◽

Process Error ◽

Submucous Cleft Palate ◽

Different Types

Purpose This purpose of this study was to assess the frequency and types of phonological process errors in patients with velopharyngeal dysfunction (VPD) and the different types of palatal anomalies. Method A total of 808 nonsyndromic patients with VPD, who underwent follow-up at the Center for Cleft Palate and Craniofacial Anomalies, from 2000 to 2016 were included. Patients were stratified into four age groups and five subphenotypes of palatal anomalies: cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP. Phonological processes were compared among groups. Results The 808 patients ranged in age from 3 to 29 years, and 439 (54.3%) were male. Overall, 262/808 patients (32.4%) had phonological process errors; 80 (59.7%) ages 3–4 years, 98 (40, 0%) ages 4.1–6 years, 48 (24.7%) 6.1–9 years, and 36 (15.3%) 9.1–29 years. Devoicing was the most prevalent phonological process error, found in 97 patients (12%), followed by cluster reduction in 82 (10.1%), fronting in 66 (8.2%), stopping in 45 (5.6%), final consonant deletion in 43 (5.3%), backing in 30 (3.7%), and syllable deletion and onset deletion in 13 (1.6%) patients. No differences were found in devoicing errors between palatal anomalies, even with increasing age. Phonological processes were found in 61/138 (44.20%) with CP, 46/118 (38.1%) with SMCP, 61/188 (32.4%) with non-CP, 70/268 (26.1%) with OSMCP, and 25/96 (26.2%) with CLP. Phonological process errors were most frequent with CP and least with OSMCP ( p = .001). Conclusions Phonological process errors in nonsyndromic VPD patients remained relatively high in all age groups up to adulthood, regardless of the type of palatal anomaly. Our findings regarding the phonological skills of patients with palatal anomalies can help clarify the etiology of speech and sound disorders in VPD patients, and contribute to general phonetic and phonological studies.

Download Full-text

Preoperative velopharyngeal closure ratio correlates with Furlow palatoplasty outcome among patients with nonsyndromic submucous cleft palate

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2020.08.005 ◽

2020 ◽

Vol 48 (10) ◽

pp. 962-968

Author(s):

Bei Zhang ◽

Chao Yang ◽

Heng Yin ◽

Qian Zheng ◽

Bing Shi ◽

...

Keyword(s):

Cleft Palate ◽

Velopharyngeal Closure ◽

Submucous Cleft Palate

Download Full-text

Nasalance Scores in Wearers of a Palatal Lift Prosthesis in Comparison with Normative Data for Japanese

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-107.1 ◽

2004 ◽

Vol 41 (3) ◽

pp. 315-319 ◽

Cited By ~ 10

Author(s):

Takashi Tachimura ◽

Yasuko Kotani ◽

Takeshi Wada

Keyword(s):

Cleft Palate ◽

Outcome Measures ◽

Normative Data ◽

Normal Limits ◽

Velopharyngeal Incompetence ◽

The Mean ◽

Velopharyngeal Function ◽

Normative Score ◽

Nasal Emission ◽

Normal Controls

Objective This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality. Design Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed. Participants Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both. Main Outcome Measures Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP. Results Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported. Conclusion A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

Download Full-text

Postoperative Velopharyngeal Closure Function Following Unified Velopharyngeal Plasty as Secondary Surgery for Cleft Palate: One- and Three-Year Follow-Up Results

Surgical Science ◽

10.4236/ss.2012.32011 ◽

2012 ◽

Vol 03 (02) ◽

pp. 59-64 ◽

Cited By ~ 1

Author(s):

Kenichi Kurita ◽

Yu Ito ◽

Atsushi Nakayama ◽

Atsushi Abe ◽

Kana Mukai ◽

...

Keyword(s):

Cleft Palate ◽

Secondary Surgery ◽

Velopharyngeal Closure ◽

Closure Function

Download Full-text

Repaired Cleft Palate and Ventilation Tubes and Their Associations with Cholesteatoma in Children and Adults

The Cleft Palate-Craniofacial Journal ◽

10.1597/08-166.1 ◽

2009 ◽

Vol 46 (6) ◽

pp. 598-602 ◽

Cited By ~ 17

Author(s):

Rudolf Reiter ◽

Stephan Haase ◽

Sibylle Brosch

Keyword(s):

Hearing Loss ◽

Cleft Palate ◽

Clinical Examination ◽

Demographic Data ◽

Ventilation Tube ◽

Tube Insertion ◽

Bilateral Hearing Loss ◽

Submucous Cleft Palate ◽

Ventilation Tubes

Objective: To determine the influence of ventilation tubes (VTs) on the formation of cholesteatoma and hearing in operated cleft palate patients with chronic ear problems. Design: Retrospective 72-month follow-up of 116 operated cleft palate patients. Patients and Interventions: Demographic data, clinical examination, and hearing were evaluated. The patients were divided according to age and type of cleft and subdivided in a subgroup with (VT+) or without ventilation tube (VT−). Main Outcome Measures: The effect of ventilation tubes (VT) on the incidence of cholesteatoma formation and degree of hearing loss in operated cleft palate patients with chronic ear problems. Results: The overall incidence of cholesteatoma was 15.5% (VT+, 14.0%; VT−, 16.7%; not significant). Bilateral hearing loss of >20 dB remained in 14.0% of the VT+ patients and in 22.7% of the VT− patients (p < .05). Submucous cleft palate (SM CP) adults (n = 15) developed high rates of cholesteatoma and hearing loss of >20 dB (both 26.7%). Conclusions: Tube insertion had no influence on the development of cholesteatoma. Adults with submucous cleft palate especially require periodic otologic evaluation because they have Eustachian tube–related otologic disease and hearing loss at a higher rate than expected.

Download Full-text

Assessment of Scar Quality after Cleft Lip Closure

The Cleft Palate-Craniofacial Journal ◽

10.1597/10-254 ◽

2012 ◽

Vol 49 (2) ◽

pp. 171-176 ◽

Cited By ~ 11

Author(s):

Franceline A. Frans ◽

Paul P.M. van Zuijlen ◽

J.P.W. Don Griot ◽

Chantai M.A.M. van Der Horst

Keyword(s):

Linear Regression ◽

Cleft Palate ◽

Cleft Lip ◽

Outcome Measure ◽

Scar Assessment ◽

Scar Quality ◽

Cleft Lip Repair ◽

A Prospective Study

Objective To assess scar quality after cleft lip repair. Design The linear scars of patients with cleft lip with or without cleft palate were evaluated in a prospective study using the Patient and Observer Scar Assessment Scale. Linear regression was performed to identify which scar characteristics were important according to patients and observer. Setting Regular outpatient follow-up visit with the cleft palate teams of two tertiary centers. Patients All consecutive patients were asked to participate in this study after informed consent, minimally 1 year postsurgery. Main Outcome Measure Scar characteristics influencing patient and observer opinion after cleft lip repair. Results A total of 86 patients with cleft lip with or without cleft palate were included, resulting in evaluation of 99 scars. Two scar characteristics, itching and pain, were seldom a concern for the patients. Linear regression showed that scars assessed longer after surgery had a better outcome. Conclusion Scar itching and pain did not seem to have an effect on patient opinion of the quality of the scar, and the majority of the patients were more satisfied with the outcome of their scar than the observer was.

Download Full-text

Unilateral Moore Pharyngoplasty in the Treatment of Unilateral or Asymmetric Velopharyngeal Incompetence

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2003_040_0263_umpitt_2.0.co_2 ◽

2003 ◽

Vol 40 (3) ◽

pp. 263-268 ◽

Cited By ~ 6

Author(s):

Felicity V. Mehendale ◽

Brian C. Sommerlad

Keyword(s):

Effective Treatment ◽

Outcome Measures ◽

Consecutive Series ◽

Gap Size ◽

Nasal Airflow ◽

Tertiary Referral ◽

Velopharyngeal Incompetence ◽

Radical Dissection

Objective To describe the use of a unilateral modification of the Moore pharyngoplasty in the treatment of unilateral or asymmetric velopharyngeal incompetence (VPI) and analyze the results in a consecutive series of patients operated on by a single surgeon. Design Blind assessment of randomized speech and nasendoscopy recordings. Setting A two-site tertiary referral cleft unit. Patients Eighteen consecutive patients with asymmetrical or unilateral VPI of varying etiology. Interventions A unilateral Moore pharyngoplasty was performed in all patients. Three patients underwent radical dissection and retropositioning of the velar muscles at the same time as the unilateral Moore pharyngoplasty. Main Outcome Measures Pre- and postoperative nasality and nasal airflow using the CAPS score, assessment of nasendoscopy recordings, and the rate of further surgery. Results There was a significant improvement in hypernasality (p = .014). There was a highly significant decrease in the size of the velopharyngeal gap on the side on which the Moore pharyngoplasty was performed (p = .004) as well as a highly significant decrease in the total gap size (p = .003). The Moore flap was effective in obliterating the lateral pharyngeal recess in 11 of 12 patients (p = .004). Three patients required further velopharyngeal surgery. Conclusions In appropriately selected patients, a unilateral Moore pharyngoplasty is a safe and effective treatment for unilateral or asymmetric VPI. If indicated, a radical dissection and retropositioning of the velar muscles may be combined with a Moore pharyngoplasty.

Download Full-text

Timing of Furlow Palatoplasty for Patients With Submucous Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617726989 ◽

2017 ◽

Vol 55 (3) ◽

pp. 430-436 ◽

Cited By ~ 6

Author(s):

Russell E. Ettinger ◽

Theodore A. Kung ◽

Natalie Wombacher ◽

Mary Berger ◽

M. Haskell Newman ◽

...

Keyword(s):

Cleft Palate ◽

Outcome Measures ◽

Primary Outcome ◽

Surgical Intervention ◽

Speech Development ◽

Velopharyngeal Insufficiency ◽

Standardized Assessments ◽

Qualitative Assessment ◽

Submucous Cleft Palate ◽

Early Surgical Intervention

Background: Submucous cleft palate (SMCP) is the most common form of cleft involving the posterior palate, resulting in variable degrees of velar dysfunction and speech disturbance. Although early surgical intervention is indicated for patients with true cleft palate, the indications for palatoplasty and timing of surgical intervention for patients with SMCP remain controversial. Methods: Twenty-nine patients with SMCP were retrospectively reviewed. Patients treated with Furlow palatoplasty were dichotomized based on patient age at the time of surgical correction into early speech development and late speech development. Primary outcome measures included standardized assessments of hypernasal resonance and quantitative pre- and postoperative nasometry scores. Patients managed nonoperatively were included for comparison of early and late speech outcomes. Results: Both early and late groups demonstrated improvement in qualitative assessment of hypernasal resonance following Furlow palatoplasty. Early and late groups also had significant improvement in pre- to postoperative nasometry scores from 7.4 to 2.3 SD from norm ( P = .01) and 6.0 to 3.6 SD from norm ( P = .02), respectively. There was no difference in postoperative nasometry scores between early and late groups, 2.3 and 3.6 SD ( P = .12). Conclusion: Furlow palatoplasty significantly improves the degree of hypernasality in patients with SMCP based on pre- and postoperative nasometry scores and on qualitative assessment of hypernasality. There were no differences in speech outcomes based on early compared with late operative intervention. Therefore, early palatal repair is not obligatory for optimal speech outcomes in children with SMCP and palatoplasty should be deferred until the emergence of overt velopharyngeal insufficiency.

Download Full-text