scholarly journals Clinical interventions and speech outcomes for individuals with submucous cleft palate

2020 ◽  
Vol 47 (6) ◽  
pp. 542-550
Author(s):  
Seung Eun Jung ◽  
Seunghee Ha ◽  
Kyung S. Koh ◽  
Tae Suk Oh
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Evaluation Criteria ◽  
Secondary Surgery ◽  
Surgical Interventions ◽  
Delayed Treatment ◽  
End Of Treatment ◽  
Diagnostic Characteristics ◽  
Submucous Cleft Palate ◽  
The Relationship

Background This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement.Methods This retrospective study included 72 children diagnosed with SMCP between 2008 and 2016. The evaluation criteria were the age of the initial visit, total number of visits, age at the end of treatment, speech problems, resonance problems, and speech therapy.Results Children with SMCP first visited the hospital at an average age of 34.32 months, and speech problems were identified at an average age of 48.53 months. Out of 72 children, 46 underwent surgery at an average age of 49.74 months. Four of these children required secondary surgery at an average age of 83.5 months. Among the children who underwent surgery before 3 years of age, 70% exhibited articulation improvements, with mild-to-moderate hypernasality. Articulation improvements showed no statistically significant differences according to age at the time of surgery. However, children who underwent surgery before 4 years had a better hypernasality rating than those who underwent surgery after 4 years of age.Conclusions Children with SMCP tend to undergo delayed treatment because the anatomical symptoms in some children with SMCP are unclear, and surgical interventions are considered only after speech problems are clarified. Starting interventions as early as possible reduces the likelihood of receiving secondary surgery and speech therapy, while increasing expectations for positive speech function at the end.

Magnetic Resonance Imaging in the Evaluation of Occult Submucous Cleft Palate

2001 ◽  
Vol 38 (5) ◽  
pp. 421-431 ◽  
Author(s):  
David P. Kuehn ◽  
Sandra L. Ettema ◽  
Michael S. Goldwasser ◽  
Joseph C. Barkmeier ◽  
Jayne M. Wachtel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cleft Palate ◽  
Muscle Tissue ◽  
Speech Therapy ◽  
Treatment Decision ◽  
Levator Muscle ◽  
Resonance Imaging ◽  
Mr Images ◽  
Submucous Cleft Palate

Objective: To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with occult submucous cleft palate and to use the MRI information obtained to aid in the treatment decision to perform surgery versus behavioral speech therapy. Design: Prospective study with magnetic resonance (MR) images of subjects suspected of having occult submucous cleft palate. Setting: Hospital and university-based. Patients: Two girls who were 4 years old at the time of palatal surgery. Intervention: Furlow double-opposing Z-plasty. Main outcome measures: MR images and clinical speech evaluations. Results: MR images provided evidence of an interruption of levator veli palatini muscle tissue in the midline and a substantial attachment of levator muscle tissue to the posterior border of the hard palate. In addition, MR images for both subjects demonstrated remarkably similar bilateral encapsulating sheaths that contained nonmuscular tissue, as confirmed subsequently during surgery. The encapsulating sheaths interrupted the normal progression of the levator muscle sling across the midline. The MR images led to the decision to perform surgery instead of speech therapy. Hypernasality was markedly reduced in both subjects after surgery. Conclusions: MRI is an effective technique for diagnosing occult submucous cleft palate and may be an important aid in the treatment decision regarding surgery versus behavioral speech therapy for patients diagnosed with occult submucous cleft palate.

Craniofacial and Pharyngeal Cephalometric Morphology in Seven-Year-Old Boys with Unoperated Submucous Cleft Palate and without a Cleft

2009 ◽  
Vol 46 (3) ◽  
pp. 314-318 ◽  
Author(s):  
Arja Heliövaara ◽  
Jorma Rautio
Keyword(s):  
Cleft Palate ◽  
Retrospective Case ◽  
Mandibular Plane ◽  
Lateral Cephalograms ◽  
Submucous Cleft Palate ◽  
Angular Measurements ◽  
Student’S T ◽  
Pharyngeal Area ◽  
The Relationship ◽  
Control Study

Objective: To evaluate cephalometrically the craniofacial and pharyngeal morphology in 7-year-old boys with unoperated submucous cleft palate and to compare the findings with the morphology of 7-year-old boys without clefts. Setting and Patients: Thirty-two boys with unoperated submucous cleft palate and 49 boys without a cleft were compared retrospectively from lateral cephalograms taken at the mean age of 7 years (range, 5.5 to 8.6 years). Design: A retrospective case-control study. Outcome Measure: Linear and angular measurements were obtained from lateral cephalograms. A Student's t test was used in the statistical analysis. Results: The maxilla of the boys with submucous cleft palate was shorter and slightly more retrusive in relation to the cranial base than that of boys without clefts. Also, the mandible of the boys with submucous cleft palate was smaller, with a steeper mandibular plane. The relationship between the jaws was similar in both groups; although, those without clefts showed higher values for soft tissue maxillary prominence. In the pharyngeal area, the boys with submucous cleft palate had larger nasopharyngeal depths, smaller hypopharyngeal depths, and shorter soft palates than the boys without a cleft. Conclusions: This small study suggests that the boys with unoperated submucous cleft palate have minor distinctive morphological features in the maxillary, mandibular, and pharyngeal areas.

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.

Hoarseness in Children with Cleft Palate

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P65-P65
Author(s):  
Katherine K Hamming ◽  
Marsha Finkelstein ◽  
James D Sidman
Keyword(s):  
Cleft Palate ◽  
Speech Therapy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Rate ◽  
Velopharyngeal Insufficiency ◽  
Additional Risk ◽  
Rate Of Speech ◽  
The Relationship ◽  
Pierre Robin

Objective 1) To determine the rate of hoarseness in children with cleft palate (CP). 2) To understand the relationship between velopharyngeal insufficiency (VPI) and hoarseness in children with CP. Methods Retrospective chart review of 98 patients treated for CP by a tertiary care Children's Hospital Cleft Team and born between 1990 and 2001. Results Of the 98 patients, 59 were male and 39 female. All types of CP were represented. 89% received speech therapy. 41.6% had VPI. The overall rate of hoarseness was 22.4% and of dysphonia was 55.9%. The presence of VPI did not correlate with the presence of hoarseness or dysphonia. However, while VPI decreased when comparing ages 3–4 (58.1%) with ages 6–7 (32.1%) (p <0.001), the hoarseness rates did not change as children got older. Additionally, there was a trend toward higher hoarseness and dysphonia rates in children with Pierre Robin Syndrome (PRS). Conclusions Both VPI and hoarseness are common findings in patients with CP. VPI improves as children get older in the setting of a tertiary care cleft team and a high rate of speech therapy. However, hoarseness and dysphonia do not appear to improve. These findings suggest that the theory that VPI causes hoarseness due to compensatory speech mechanisms may be incorrect. Even when resonance problems have improved, CP patients should continue to be evaluated by speech therapists for voice disturbances, as well as evaluated by otolaryngologists for treatable causes of hoarseness. Further, patients with PRS may be at additional risk for voice disturbances and should be treated accordingly.

Cephalometric Analysis in Submucous Cleft Palate: Comparison of Cephalometric Data Obtained from Submucous Cleft Palate Patients with Velopharyngeal Competence and Incompetence

2002 ◽  
Vol 39 (1) ◽  
pp. 105-109 ◽  
Author(s):  
Susam Park ◽  
Makoto Omori ◽  
Kogo Kato ◽  
Naotugu Nitta ◽  
Ichiko Kitano ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Orthodontic Treatment ◽  
Strong Relationship ◽  
Prognostic Indicator ◽  
Cephalometric Analysis ◽  
Submucous Cleft Palate ◽  
Velopharyngeal Function ◽  
The Relationship

Objective The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate. Design and Patients Fifty-two lateral cephalometric radiographs of 46 sub-mucous cleft palate (SMCP) patients with velopharyngeal competence (24 patients) and incompetence (22 patients) at 4 and 7 years of age were studied. The patients had not received any surgical or orthodontic treatment prior to cephalography being performed. Results Significant differences were found between cephalometric variables (N-Ba, N-S-Ba angle) in children with velopharyngeal competence and incompetence. However, the results of our study showed that cephalometric data alone are not useful for predicting velopharyngeal function and can not serve as an absolute prognostic indicator. Conclusion There are many factors that can influence velopharyngeal function in SMCP patients. Cephalometric data did not demonstrate a strong relationship to velopharyngeal function.

scholarly journals Anti-EDAR Agonist Antibody Therapy Resolves Palate Defects in Pax9-/- Mice

2017 ◽  
Vol 96 (11) ◽  
pp. 1282-1289 ◽  
Author(s):  
S. Jia ◽  
J. Zhou ◽  
Y. Wee ◽  
M.L. Mikkola ◽  
P. Schneider ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Signaling Pathway ◽  
Single Gene ◽  
Antibody Therapy ◽  
Well Being ◽  
Surgical Interventions ◽  
Single Gene Disorders ◽  
Unbiased Gene ◽  
Relationship Of ◽  
The Relationship

To date, surgical interventions are the only means by which craniofacial anomalies can be corrected so that function, esthetics, and the sense of well-being are restored in affected individuals. Unfortunately, for patients with cleft palate—one of the most common of congenital birth defects—treatment following surgery is prolonged over a lifetime and often involves multidisciplinary regimens. Hence, there is a need to understand the molecular pathways that control palatogenesis and to translate such information for the development of noninvasive therapies that can either prevent or correct cleft palates in humans. Here, we use the well-characterized model of the Pax9−/− mouse, which displays a consistent phenotype of a secondary cleft palate, to test a novel therapeutic. Specifically, we demonstrate that the controlled intravenous delivery of a novel mouse monoclonal antibody replacement therapy, which acts as an agonist for the ectodysplasin (Eda) pathway, can resolve cleft palate defects in Pax9−/− embryos in utero. Such pharmacological interventions did not reverse the arrest in tooth, thymus, and parathyroid gland development, suggesting that the relationship of Pax9 to the Eda/Edar pathway is both unique and essential for palatogenesis. Expression analyses and unbiased gene expression profiling studies offer a molecular explanation for the resolution of palatal defects, showing that Eda and Edar-related genes are expressed in normal palatal tissues and that the Eda/Edar signaling pathway is downstream of Pax9 in palatogenesis. Taken together, our data uncover a unique relationship between Pax9 and the Eda/Edar signaling pathway that can be further exploited for the development of noninvasive, safe, and effective therapies for the treatment of cleft palate conditions and other single-gene disorders affecting the craniofacial complex.

Submucous Cleft Palate: Evaluation and Treatment Principles for Speech-Language Pathologists

2020 ◽  
Vol 5 (6) ◽  
pp. 1482-1491 ◽  
Author(s):  
Graham C. Schenck
Keyword(s):  
Cleft Palate ◽  
Best Practice ◽  
Speech Therapy ◽  
Craniofacial Anomalies ◽  
Review Of The Literature ◽  
Speech Language Pathologists ◽  
Unique Challenge ◽  
Perceptual Evaluation ◽  
Submucous Cleft Palate ◽  
Practical Recommendations

Purpose This clinical focus article intends to provide speech-language pathologists (SLPs) with a review of the literature and practical recommendations for the evaluation and treatment of individuals with submucous cleft palate (SMCP). Method A review of the literature focused on definition, incidence, and diagnostic recommendations for SMCP was completed. Descriptions of physical and auditory–perceptual features common during evaluation were described in detail. Guiding principles for clinical management related to surgery and/or speech therapy were provided. Results Several discrepancies in the definition, incidence, and outcomes across SMCP studies were discovered in the literature. The importance of a comprehensive perceptual evaluation, including an oral mechanism examination by an SLP trained in the assessment of individuals with craniofacial anomalies, was emphasized. Conclusions SMCP is a less understood subtype of cleft palate that presents a unique challenge for clinicians. A trained SLP's comprehensive perceptual evaluation and thorough oral mechanism examination are critical for diagnosis and treatment. SLPs can promote best practice for this population by initiating referrals to an accredited cleft palate–craniofacial team for further evaluation of their speech and assessment of surgical candidacy.

scholarly journals Surgical management in submucous cleft palate patients

2021 ◽  
Author(s):  
B. J. A. Smarius ◽  
C. H. A. L. Guillaume ◽  
J. Slegers ◽  
A. B. Mink van der Molen ◽  
C. C. Breugem
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Speech Therapy ◽  
Post Surgery ◽  
Age At Surgery ◽  
Submucous Cleft Palate ◽  
Age Of Diagnosis ◽  
Buccal Flap ◽  
Nasal Regurgitation

Abstract Objectives The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children. Patient and methods Medical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies. Results In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap). Conclusion This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected. Clinical relevance Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.

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