Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

  • Received : 2016.08.02
  • Accepted : 2017.03.22
  • Published : 2017.05.22
Download PDF
⟨ Previous Next ⟩

Abstract

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ${\geq}17$ years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Keywords

References

  1. Mossey PA, Little J, Munger RG, et al. Cleft lip and palate. Lancet 2009;374:1773-85. https://doi.org/10.1016/S0140-6736(09)60695-4
  2. Schweckendiek H. The problem of early and late surgery in congenital fissure of the of the lips and palate. Z Laryngol Rhinol Otol 1951;30:51-6.
  3. Schweckendiek W, Doz P. Primary veloplasty: long-term results without maxillary deformity. a twenty-five year report. Cleft Palate J 1978;15:268-74.
  4. Bardach J, Morris HL, Olin WH. Late results of primary veloplasty: the Marburg Project. Plast Reconstr Surg 1984;73:207-18. https://doi.org/10.1097/00006534-198402000-00007
  5. Witzel MA, Salyer KE, Ross RB. Delayed hard palate closure: the philosophy revisited. Cleft Palate J 1984;21:263-9.
  6. Perko MA. Two-stage closure of cleft palate (progress report). J Maxillofac Surg 1979;7:46-80.
  7. Lohmander A, Friede H, Lilja J. Long-term, longitudinal follow-up of individuals with unilateral cleft lip and palate after the Gothenburg primary early veloplasty and delayed hard palate closure protocol: speech outcome. Cleft Palate Craniofac J 2012;49:657-71. https://doi.org/10.1597/11-085
  8. Von Langenbeck B. Operation der angeborenen totalen spaltung des harten gaumens nach einer neuer methode. Dtsch Arch Klin Med 1861;8:231.
  9. Mink van der Molen AB, Janssen K, Specken TF, et al. The modified Honig velopharyngoplasty: a new technique to treat hypernasality by palatal lengthening. J Plast Reconstr Aesthet Surg 2009;62:646-9. https://doi.org/10.1016/j.bjps.2007.12.023
  10. Meijer MF. Testing speech of children born with a cleft: a report from the Speech therapy workgroup from the Dutch Association for Cleft Palate and Craniofacial Anomalies. Amsterdam, NL: Vrije Universiteit Medisch Centrum; 2003.
  11. van de Weijer J, Slis I. Nasaliteitsmeting met de nasometer. Logop Foniatr 1991;63:97-101.
  12. Lowry R. Kappa as a measure of concordance in categorical sorting [Internet]. Poughkeepsie, NY: Richard Lowry; c2001-2017 [cited 2015 Mar 20]. Available from: http://vassarstats.net/.
  13. Ross RB. Treatment variables affecting growth in unilateral cleft lip and palate. Part 5: timing of palate repair. Cleft Palate J 1987;24:54-63.
  14. Holland S, Gabbay JS, Heller JB, et al. Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plast Reconstr Surg 2007;119:1302-10. https://doi.org/10.1097/01.prs.0000258518.81309.70
  15. Sell D. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord 2005;40:103-21. https://doi.org/10.1080/13682820400016522
  16. Enemark H, Bolund S, Jorgensen I. Evaluation of unilateral cleft lip and palate treatment: long term results. Cleft Palate J 1990;27:354-61. https://doi.org/10.1597/1545-1569(1990)027<0354:EOUCLA>2.3.CO;2
  17. Schnitt DE, Agir H, David DJ. From birth to maturity: a group of patients who have completed their protocol management. Part I. Unilateral cleft lip and palate. Plast Reconstr Surg 2004;113:805-17. https://doi.org/10.1097/01.PRS.0000105332.57124.89
  18. Semb G, Brattstrom V, Molsted K, et al. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 1: introduction and treatment experience. Cleft Palate Craniofac J 2005;42:64-8. https://doi.org/10.1597/02-119.1.1
  19. Jackson O, Stransky CA, Jawad AF, et al. The Children's Hospital of Philadelphia modification of the Furlow doubleopposing Z-palatoplasty: 30-year experience and long-term speech outcomes. Plast Reconstr Surg 2013;132:613-22. https://doi.org/10.1097/PRS.0b013e31829ad109
  20. Farzaneh F, Becker M, Peterson AM, et al. Speech results in adult Swedish patients born with unilateral complete cleft lip and palate. Scand J Plast Reconstr Surg Hand Surg 2008;42:7-13. https://doi.org/10.1080/02844310701694522
  21. Van Lierde KM, Monstrey S, Bonte K, et al. The long-term speech outcome in Flemish young adults after two different types of palatoplasty. Int J Pediatr Otorhinolaryngol 2004;68:865-75. https://doi.org/10.1016/j.ijporl.2004.01.020
  22. Lilja J, Mars M, Elander A, et al. Analysis of dental arch relationships in Swedish unilateral cleft lip and palate subjects: 20-year longitudinal consecutive series treated with delayed hard palate closure. Cleft Palate Craniofac J 2006;43:606-11. https://doi.org/10.1597/05-069
  23. Landheer JA, Breugem CC, van der Molen AB. Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure. Cleft Palate Craniofac J 2010;47:623-30. https://doi.org/10.1597/09-069
  24. Wyatt R, Sell D, Russell J, et al. Cleft palate speech dissected: a review of current knowledge and analysis. Br J Plast Surg 1996;49:143-9. https://doi.org/10.1016/S0007-1226(96)90216-7
  25. Leclerc JE, Godbout A, Arteau-Gauthier I, et al. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients. Laryngoscope 2014;124:561-9. https://doi.org/10.1002/lary.24200

Cited by

  1. Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate : A Randomized Controlled Trial vol.143, pp.3, 2017, https://doi.org/10.1097/prs.0000000000005346
  2. Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review vol.77, pp.2, 2017, https://doi.org/10.1016/j.joms.2018.09.027
  3. Quality of Life and Patient Satisfaction in Adults Treated for a Cleft Lip and Palate: A Qualitative Analysis vol.56, pp.9, 2017, https://doi.org/10.1177/1055665619843410
  4. Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair vol.57, pp.8, 2017, https://doi.org/10.1177/1055665620913440
  5. Regeneration in Experimental Alveolar Bone Defect Using Human Umbilical Cord Mesenchymal Stem Cells vol.30, pp.None, 2017, https://doi.org/10.1177/0963689720975391