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.

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.

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.

Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

2019 ◽  
Vol 57 (4) ◽  
pp. 420-429
Author(s):  
Susanna Botticelli ◽  
Annelise Küseler ◽  
Kirsten Mølsted ◽  
Helene Soegaard Andersen ◽  
Maria Boers ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Controlled Trial ◽  
Velopharyngeal Insufficiency ◽  
Primary Surgery ◽  
Multicenter Randomized Controlled Trial ◽  
Palate Repair ◽  
Velopharyngeal Function

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

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

2004 ◽  
Vol 41 (3) ◽  
pp. 315-319 ◽  
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.

The State of the Art in Cleft Palate Surgery

2000 ◽  
Vol 37 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Don Larossa
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
State Of The Art ◽  
Historical Context ◽  
Current Understanding ◽  
Multiple Methods ◽  
Advantages And Disadvantages ◽  
Palate Repair

Overview This update focuses on current practices and controversies in surgical repair of the hard and soft palate posterior to the alveolus. Our current understanding of the advantages and disadvantages of presurgical active and passive manipulation of the hard palate shelves including the use of periosteoplasty is reviewed. The evolution of the multiple methods of repair of the hard and soft palate is given in a historical context along with a discussion of the concerns about timing of palate repair.

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.

Musculature of the Soft Palate: Clinico-anatomic Correlations and Therapeutic Implications in the Treatment of Cleft Palates

1997 ◽  
Vol 34 (3) ◽  
pp. 189-194
Author(s):  
Christian Vacher ◽  
Bernard Pavy ◽  
Jeffrey Ascherman
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Nasal Mucosa ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
Posterior Border ◽  
Therapeutic Implications ◽  
Sagittal Orientation

Objective Hypoptasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare In our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. Method We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. Results In cleft palates, the muscular fibers have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. Conclusion The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.

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.

Results of Cleft Palate Repair with the Double-Reverse Z-Plasty Performed by Residents

1994 ◽  
Vol 111 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Eric A. Mann ◽  
James D. Sidman
Keyword(s):  
Postoperative Complications ◽  
Soft Palate ◽  
Hard Palate ◽  
Operating Time ◽  
Oral Intake ◽  
Technical Difficulty ◽  
Functional Results ◽  
Complication Rates ◽  
Estimated Blood Loss ◽  
Velopharyngeal Function

The double-reverse Z-plasty (Furlow) repair of soft palate clefts has the advantages of lengthening the soft palate while reconstructing the palatal muscle sling to optimize velopharyngeal function. Because soft tissue from the hard palate is not mobilized to lengthen the soft palate, this technique has an additional theoretic advantage of minimizing disturbances of maxillofacial growth. Cited disadvantages of the technique include increased technical difficulty and operating time compared with other procedures. We performed a retrospective study of 20 consecutive Furlow repairs of the soft palate performed by residents under supervision of one attending surgeon between 1989 and 1992. All children had complete cleft of the soft palate; 14 had incomplete cleft and six had complete cleft of the hard palate, which were repaired by a modified Von Langenbeck technique or with vomer flaps. Mean age of patients was 15 months, and mean operating time (including placement of pressure-equalizing tubes) was 162 minutes, with an average estimated blood loss of less than 25 ml. Average time until adequate oral intake was achieved was 1.7 days, and duration of hospitalization averaged 2.4 days. Immediate postoperative complications included transient tongue edema in one patient and atelectasis and pneumonia in one patient with multiple congenital anomalies. Delayed postoperative complications included symptoms of sleep apnea in four patients, which subsequently improved after tonsillectomy and/or superior adenoidectomy. Fistulas occurred in two patients (10%), which compares favorably with published results of other techniques. Preliminary functional evaluations reveal that all repairs appear to have adequate length and good mobility; speech evaluations are in progress. Thus the double-reverse Z-plasty technique can be effectively taught to residents, and acceptable complication rates and functional results can be achieved.

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