Archives of Plastic Surgery

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

DOI QR Code

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate

  • Mona Haj (Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital) ;
  • S.N. Hakkesteegt (Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital) ;
  • H.G. Poldermans (Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital) ;
  • H.H.W. de Gier (Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Sophia Children's Hospital) ;
  • S.L. Versnel (Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Sophia Children's Hospital) ;
  • E.B. Wolvius (Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital)
  • Received : 2023.08.03
  • Accepted : 2024.04.09
  • Published : 2024.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG). Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively. Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% (p < 0.001). Grimacing decreased in 27% (p = 0.015). Articulation disorders remained present in 85% (p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively (p < 0.001). Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Keywords

References

  1. Fox D, Lynch J, Brookshire B. Selected developmental factors of cleft palate children between two and thirty-three months of age. Cleft Palate J 1978;15(03):239-245 
  2. Kummer AW. Speech evaluation for patients with cleft palate. Clin Plast Surg 2014;41(02):241-251 
  3. Kummer AW, Briggs M, Lee L. The relationship between the characteristics of speech and velopharyngeal gap size. Cleft Palate Craniofac J 2003;40(06):590-596 
  4. Kummer AW. Speech therapy for errors secondary to cleft palate and velopharyngeal dysfunction. Semin Speech Lang 2011;32(02):191-198 
  5. Chapman KL. Phonologic processes in children with cleft palate. Cleft Palate Craniofac J 1993;30(01):64-72 
  6. Chapman KL. Is presurgery and early postsurgery performance related to speech and language outcomes at 3 years of age for childrenwith cleft palate? Clin Linguist Phon 2004;18(4-5):235-257 
  7. Shaye D. Update on outcomes research for cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg 2014;22(04):255-259 
  8. Lohmander-Agerskov A. Speech outcome after cleft palate surgery with the Goteborg regimen including delayed hard palate closure. Scand J Plast Reconstr Surg Hand Surg 1998;32(01):63-80 
  9. Kelly SN, Shearer J. Appearance and speech satisfaction and their associations with psychosocial difficulties among young people with cleft lip and/or palate. Cleft Palate Craniofac J 2020;57(08):1008-1017 
  10. Al-Omari I, Millett DT, Ayoub AF. Methods of assessment of cleft-related facial deformity: a review. Cleft Palate Craniofac J 2005;42(02):145-156 
  11. de Ladeira PR, Alonso N. Protocols in cleft lip and palate treatment: systematic review. Plast Surg Int 2012;2012:562892 
  12. Semb G, Shaw WC. Facial growth after different methods of surgical intervention in patients with cleft lip and palate. Acta Odontol Scand 1998;56(06):352-355 
  13. Wlodarczyk JR, Brannon B, Munabi NCO, et al. A meta-analysis of palatal repair timing. J Craniofac Surg 2021;32(02):647-651 
  14. Van Lierde KM, Monstrey S, Bonte K, Van Cauwenberge P, Vinck B. The long-term speech outcome in Flemish young adults after two different types of palatoplasty. Int J Pediatr Otorhinolaryngol 2004;68(07):865-875 
  15. Sell D. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord 2005;40(02):103-121 
  16. Meijer M. Afwijkingen. WlvdNVvSeC. Het logopedisch onderzoek van kinderen, geboren met een schisis. ZonMW. 2003 
  17. Laowansiri U, Behrents RG, Araujo E, Oliver DR, Buschang PH. Maxillary growth and maturation during infancy and early childhood. Angle Orthod 2013;83(04):563-571 
  18. Cornelissen AM, Maltha JC, Von den Hoff HW, Kuijpers-Jagtman AM. Palatal mucoperiosteal wound healing in the rat. Eur J Oral Sci 1999;107(05):344-351 
  19. Li J, Johnson CA, Smith AA, et al. Disrupting the intrinsic growth potential of a suture contributes to midfacial hypoplasia. Bone 2015;81:186-195 
  20. Voshol IE, van der Wal KG, van Adrichem LN, Ongkosuwito EM, Koudstaal MJ. The frequency of Le Fort I osteotomy in cleft patients. Cleft Palate Craniofac J 2012;49(02):160-166 
  21. Good PM, Mulliken JB, Padwa BL. Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J 2007;44(04):396-401 
  22. Daskalogiannakis J, Mehta M. The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate. Cleft Palate Craniofac J 2009;46(05):498-502 
  23. Rosenstein S, Kernahan D, Dado D, Grasseschi M, Griffith BH. Orthognathic surgery in cleft patients treated by early bone grafting. Plast Reconstr Surg 1991;87(05):835-892, discussion 840-842 
  24. DeLuke DM, Marchand A, Robles EC, Fox P. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. J Oral Maxillofac Surg 1997;55(07):694-697, discussion 697-698 
  25. 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(06):657-671 
  26. Kappen IFPM, Bittermann D, Janssen L, et al. 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. Arch Plast Surg 2017;44(03):202-209 
  27. Hortis-Dzierzbicka M, Radkowska E, Fudalej PS. Speech outcomes in 10-year-old children with complete unilateral cleft lip and palate after one-stage lip and palate repair in the first year of life. J Plast Reconstr Aesthet Surg 2012;65(02):175-181 
  28. Kummer AW. Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management. 4th ed. Burlington, MA:: Jones & Bartlett Learning; 2018 
  29. Haque S, Alam MK, Khamis MF. Factors responsible for unfavorable dental arch relationship in non syndromic unilateral cleft lip and palate children. J Clin Pediatr Dent 2017;41(03):236-242 
  30. Noordhoff MS, Kuo J, Wang F, Huang H, Witzel MA. Development of articulation before delayed hard-palate closure in children with cleft palate: a cross-sectional study. Plast Reconstr Surg 1987;80(04):518-524 
  31. Liao YF, Yang IY, Wang R, Yun C, Huang CS. Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate. Plast Reconstr Surg 2010;125(05):1503-1510 
  32. Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 1987;24(01):5-77 
  33. Shaw WC, Semb G, Nelson P, et al. The Eurocleft project 1996-2000: overview. J Craniomaxillofac Surg 2001;29(03):131-140, discussion 141-142 
  34. Perko MA. Two-stage closure of cleft palate (progress report). J Maxillofac Surg 1979;7(01):46-80 
  35. Mommaerts MY, Kablan F, Sheth S, Laster Z. Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair. J Maxillofac Sur 2003;31(04):209-214 
  36. Arora J, Haj M. Case Study: Implementing ICHOM's Standard Sets of Outcomes - Erasmus Medical Centre in the Netherlands. London, UK: International Consortium for Health Outcomes Measurement (ICHOM). 2016. Accessed May 1, 2024 at: http://www.ichom.org/news/case-study-implementing-ichoms-standard-sets-of-outcomes-erasmus-medical-centre-in-the-netherlands/ 
  37. Haj M, de Gier HHW, van Veen-van der Hoek M, et al. [Improving care for cleft lip and palate patients: uniform and patient-orientated outcome measures]. Ned Tijdschr Tandheelkd 2018;125(02):70-75