scholarly journals The Relationship between the Type of Cleft and Nasal Air Emission in Speech of Children with Cleft Palate or Cleft Lip and Palate

2019 ◽  
Vol 7 (3) ◽  
pp. 352-357
Author(s):  
Tatjana Georgievska-Jancheska
Keyword(s):  
Cleft Palate ◽  
Speech Production ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Velopharyngeal Insufficiency ◽  
P Value ◽  
Air Emission ◽  
Perceptual Assessment ◽  
Assessment Procedures ◽  
The Relationship

BACKGROUND: Cleft palate, due to damage of the soft palate, leads to dysfunction, i.e., inappropriate closure of the velopharynx during speech production, thus resulting in velopharyngeal insufficiency which characterises with hypernasal speech and nasal air loss/emission during speech production. AIM: To establish the relationship between the type of cleft according to the Veau classification and the degree of nasal air emission in the speech of patients with cleft using auditory-visual perceptual assessment procedures. MATERIAL AND METHODS: A group of 40 patients with irregular speech aged 4 to 7, out of which 20 with cleft palate or cleft lip and palate, participated in the research. The Veau classification was used to classify the cleft severity, while an indirect instrumental examination was conducted with the See-Scape instrument to detect nasal air emission during the speech. RESULTS: The respondents with cleft palate or cleft lip and palate of higher Veau class had a greater degree of nasal air emission during the speech. There is a positive, statistically significant correlation between the results obtained with the Veau classification of cleft lip and palate, and the degree of nasal air emission. The value of Spearman’s coefficient of correlation is R = 0.46, and the calculated p-value is p = 0.04. CONCLUSION: A more severe cleft type is associated with an increased degree of nasal air emission during the speech, and vice versa.

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.

Perceptual Evaluation of Speech and Velopharyngeal Function in Children with and without Cleft Palate and the Relationship to Nasal Airflow Patterns

2002 ◽  
Vol 39 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Hans Dotevall ◽  
Anette Lohmander-Agerskov ◽  
Hasse Ejnell ◽  
Björn Bake
Keyword(s):  
Cleft Palate ◽  
Sensitivity And Specificity ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Strong Association ◽  
Airflow Rate ◽  
Nasal Airflow ◽  
Perceptual Evaluation ◽  
Velopharyngeal Function ◽  
The Relationship

Objectives The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate. Participants Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers. Method Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of “velopharyngeal function” and “hypernasality.” Results A strong association was found between ratings of “velopharyngeal function” and “hypernasality” and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of “velopharyngeal function.” The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of “hypernasality.” Conclusion Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Conversational Skills of Children with Cleft Lip and Palate: A Replication and Extension

2006 ◽  
Vol 43 (2) ◽  
pp. 179-188 ◽  
Author(s):  
Melissa S. Frederickson ◽  
Kathy L. Chapman ◽  
Mary Hardin-Jones
Keyword(s):  
Speech Production ◽  
Cleft Lip ◽  
Significant Positive Correlation ◽  
Cleft Lip And Palate ◽  
Individual Child ◽  
Language Performance ◽  
Positive Correlation ◽  
Conversational Skills ◽  
Conversational Interactions ◽  
The Relationship

Objective To replicate and to extend a previous study examining the conversational skills of children with cleft lip and palate. Participants Thirty-four children (33 to 44 months) participated: 17 children with cleft lip and palate and 17 noncleft children. Methods The children were observed during an interaction with caregivers in their homes. Samples of caregiver-child interactions were coded as assertive or responsive, for type of conversational act, and for discourse level categories. Profiles of conversational activity were determined for each child based on the coding. Correlations were performed to examine the relationship between assertiveness and speech variables (articulation and resonance) for the children with cleft lip and palate. Results Group comparisons revealed that the children with cleft lip and palate produced fewer assertive utterances, were less likely to respond adequately to comments by caregivers, and produced more topic maintaining and fewer topic extending utterances than did their noncleft peers during conversational interactions. Examination of individual child data indicated that 35% of the children with cleft lip and palate exhibited conversational profiles characterized by either low assertiveness or low responsiveness. Finally, a significant positive correlation was noted between conversational assertiveness and speech production skills. Conclusion These findings suggested that the children with cleft lip and palate were less conversationally assertive than their noncleft peers. Further, there appeared to be a relationship between speech production skills and conversational skills, suggesting that poor speech may be impacting language performance for these children.

Is Isolated Palatal Anomaly an Indication to Screen for 22q11 Region Deletion?

2003 ◽  
Vol 40 (2) ◽  
pp. 176-179 ◽  
Author(s):  
Orit Reish ◽  
Yehuda Finkelstein ◽  
Ronit Mesterman ◽  
Ariela Nachmani ◽  
Baruch Wolach ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Young Patients ◽  
Velocardiofacial Syndrome ◽  
Clinical Findings ◽  
Velopharyngeal Insufficiency ◽  
Facial Dysmorphism ◽  
22Q11 Deletion ◽  
22Q11 Region

Objective Velocardiofacial syndrome (VCFS) is the most common multiple anomaly disorder associated with palatal clefting. Cytogenetic hemizygous deletion of 22q11 region is found in 80% of patients. The frequency of 22q11 deletion in patients presenting with isolated palatal anomalies has not been fully assessed. Our objective was to determine the frequency of the deletion in patients with isolated palatal anomalies. Design Patients were referred because of velopharyngeal insufficiency because of isolated congenital palatal anomalies. Diagnosis of palatal anomalies was confirmed by videonasopharyngoscopy, multiview videofluoroscopy and cephalometry. Other clinical findings suggestive of VCFS were sought, and subjects with these characteristics were excluded from the study. Peripheral blood samples from all patients were analyzed cytogenetically utilizing fluorescent in situ hybridization for the 22q11 region. Results Thirty-eight patients aged 3 to 31 years were included in the study. Nine had cleft palate, 7 cleft lip and palate, 10 overt and 11 occult submucous cleft palate, and 1 had a deep nasopharynx. No deletion of 22q11 region was detected in any of the evaluated patients. Conclusions A routine screening for the 22q11 deletion in older children and adults presenting with an isolated palatal anomaly may not be required. Because other signs related to VCFS such as facial dysmorphism and behavioral or psychiatric disorders may evolve at an older age, young patients should be followed up and reevaluated for additional relevant symptoms that may lead to deletion evaluation. In light of the fact that the current literature is inconsistent, the relative small size of this study and the significant consequences of missed 22q11.2 deletion, more information is needed before definitive recommendations can be made.

scholarly journals Velopharyngeal Closure and Resonance in Children Following Early Cleft Palate Repair: Outcome Measurement

2019 ◽  
Vol 52 (02) ◽  
pp. 201-208
Author(s):  
V. S. Aparna ◽  
M. Pushpavathi ◽  
Krishnamurty Bonanthaya
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Outcome Measurement ◽  
Treatment Protocols ◽  
Air Emission ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Speech Assessment

Abstract Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery. Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair. Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction. Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality. Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.

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.

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.

An Investigation of the Relationship between Associated Congenital Malformations and the Mental and Psychomotor Development of Children with Clefts

2003 ◽  
Vol 40 (3) ◽  
pp. 297-303 ◽  
Author(s):  
Henriëtte F. N. Swanenburg de Veye ◽  
Frits A. Beemer ◽  
Gideon J. Mellenbergh ◽  
Wim H. G. Wolters ◽  
Josien A. Heineman-de Boer
Keyword(s):  
Cleft Palate ◽  
Congenital Malformations ◽  
Infant Development ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Psychomotor Development ◽  
Dutch Version ◽  
Cross Sectional ◽  
The Relationship

Objective This research studied the relationship between associated congenital malformations and the mental and psychomotor development of children with clefts. Design The study was cross-sectional. Setting The study was conducted in a university hospital for children. Participants The sample consisted of 148 children with cleft lip, cleft palate, or both. Main Outcome Measures The children were assessed by a clinical geneticist at the age of 18 months. The children's level of development was determined by means of the Dutch version of the Bayley Scales of Infant Development. Results One-third of the total sample had associated malformations. Children with an isolated cleft lip showed the least. Children with an isolated cleft palate showed the highest percentage of minor malformations that are minor yet possibly worrisome. The total group achieved a mean developmental index (DI) on the mental scale of 98.9 with SD of 20.9. The motor scale showed a mean DI of 104.9 and SD of 24.7. Analysis of variance (ANOVA) showed that on the mental scale, the three main effects (diagnosis, evaluation, and sex) were significant at the 5% level. On the motor scale, only the main effect “evaluation” was significant. Conclusions This study demonstrated that children with associated congenital malformations might be disadvantaged with respect to their development. These malformations occurred most frequently with the cleft lip and palate and cleft palate only subgroups. More research, especially concerning the cleft palate only subgroup is needed because they are most at risk.

Quality of Life in Patients With Velopharyngeal Insufficiency in West China

2021 ◽  
pp. 105566562110341
Author(s):  
Lidan Lu ◽  
Aipiziguli Yakupu ◽  
Yanhui Wu ◽  
Xiangnan Li ◽  
Pengxin Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Cleft Lip And Palate ◽  
Generalized Linear Mixed Model ◽  
Velopharyngeal Insufficiency ◽  
Caregiver Report

Objective This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. Design This is a cross-sectional study. Setting The study was conducted in a tertiary medical center. Participants The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. Main Outcome Measure(s) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann–Whitney U test was used to evaluate the patients’ sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. Results In the univariate analysis, patients’ age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. Conclusions By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.

scholarly journals Evaluasi Hasil Labioplasti Menggunakan Skor CLEFT-Q

e-CliniC ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 561
Author(s):  
Feldy Deki ◽  
Mendy Hatibie ◽  
Maximillian Ch. Oley ◽  
Fredrik G. Langi
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Patient Reports ◽  
A Value ◽  
Preliminary Study ◽  
And Gender ◽  
The Relationship ◽  
Normative Value ◽  
Variable Analysis

Abstract: Application of CLEFT-Q score instrument in the assessment of surgical outcomes for cleft lip and/or cleft palate based on patient reports is still relatively new. This study was aimed to establish the normative value of the Indonesian version of CLEFT-Q score in post-cleft lip surgery patients and to differentiate the results of cleft lip surgery according to the score based on the type of cleft, age, and sex. This was a preliminary study using the Indonesian CLEFT-Q instrument. Patients were interviewed for filling out the Indonesian version of CLEFT-Q after surgery. There were 75 samples in this study. Significant results were found in the association between age and CLEFT-Q score (p<0.05 and R>0.35). Variable selection for multi-variable analysis included cleft type and age in the model, where age alone indicated a significant relationship. The linear regression model involved the relationship between CLEFT-Q scores and gender, age, and cleft type as covariates. The correlation shown was classified as having moderate strength (R=0.46) for all covariates. In conclusion, the normative value of the Indonesian version of CLEFT-Q score with an approach to post-cleft lip surgery patients got a value that was in accordance with the highest standard in the literature, namely 91. The results of cleft lip surgery according to the Indonesian version of CLEFT-Q score based on the type of cleft, age and gender can be applied according to the literature.Keywords: cleft lip; cleft palate; cleft lip and palate; Indonesian version of CLEFT-Q Abstrak: Penerapan skor CLEFT-Q dalam penilaian luaran operasi bibir sumbing dan/atau langit-langit terbelah berdasarkan laporan pasien masih relatif baru. Penelitian ini bertujuan untuk mene-gakkan nilai normatif skor CLEFT-Q berbahasa Indonesia pada pasien pasca operasi bibir sum-bing serta membedakan hasil operasi bibir sumbing menurut skor tersebut berdasarkan tipe cleft, usia, dan jenis kelamin. Jenis penelitian ialah studi pendahuluan penggunaan CLEFT-Q berbahasa Indonesia. Pasien diwawancarai untuk melakukan pengisian CLEFT-Q berbahasa Indonesia setelah operasi. Hasil penelitian mendapatkan total 75 sampel. Hasil bermakna ditemukan pada hubungan antara usia dan skor CLEFT-Q (p <0,05 dan R > 0,35). Seleksi variabel untuk analisis multivariabel mengikutsertakan tipe cleft dan usia di dalam model, dan variabel usia saja yang mengindikasikan adanya hubungan bermakna (95% CI 1,15-2,33; p=0,006). Model regresi linear melibatkan hubungan antara skor CLEFT-Q dengan jenis kelamin, usia, dan tipe cleft sebagai kovariat dan mendapatkan korelasi kekuatan sedang (R=0,46) untuk semua kovariat. Simpulan penelitian ini ialah nilai normatif skor CLEFT-Q berbahasa Indonesia dengan pendekatan terhadap pasien pasca operasi bibir sumbing mendapatkan nilai yang sesuai dengan standar tertinggi pada kepustakaan yaitu 91. Hasil operasi bibir sumbing menurut skor CLEFT-Q berbahasa Indonesia berdasarkan tipe cleft, umur dan jenis kelamin dapat diterapkan sesuai kepustakaan.Kata kunci: cleft lip; cleft palate; cleft lip and palate; skor CLEFT-Q berbahasa Indonesia

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