• Archives of Plastic Surgery
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• v.44 no.3
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• pp.202-209
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• 2017

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.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.112-122
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• 2001

Background: Cleft lip and palate deformity have unknown patterns of maxillofacial growth and development. The maxillofacial growth can be affected either by congenital or environmental factors such as infection and trauma. Surgical repair of cleft lip and palate may interfere the subsequent growth and development of maxillofacial region. The purpose of this study is to evaluate the characteristics of maxillofacial growth patterns in adult cleft lip and palate patients. Materials and Methods: The material for this study consisted of 17 adult male patients with cleft lip and palate. Cephalometric tracing and measurements were done by one investigator. The relationship between 17 cleft lip and palate patients and Korean norms were evaluated statistically. Results: There were statistically differences in Na. perpendicular to point A, SNA angle, effective maxillary length, maxillofacial differencial. Wit's appraisal and upper incisor to point A(p < 0.01). Pogonion to Na. perpendicular also statistically differed(p < 0.05). Other measurements didn't statistically differ. Conclusion: It was evident that in adult cleft lip and palate patients, maxilla was retruded and short. Careful cleft lip and palate repair and treatment are recommended for facilitating normal growth of maxilla.

• The Journal of the Korean dental association
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• v.47 no.10
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• pp.656-668
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• 2009

It is difficult to perform orthodontic treatment for cleft lip and palate patient. Although there are many orthodontic appliances to expand narrowed maxillary arch, results are rarely successful and the possibility of relapse is increased due to severe scars. Self-ligating bracket, recently used in orthodontic treatment, suggests solution of crowding by expansion of dental arches. Light and continuous force could apply for orthodontic movement due to characteristic low friction of self ligating bracket, which gives expansion force until dentition reaches its new equilibrium position and it can be expressed as spontaneous lateral expansion with heavy labial tension. This kind of expansion force is thought to be a possibility of expanding the constricted maxillary arch of cleft lip and palate patient. Repositioning of the maxilla by Le Fort I osteotomy in case of severe maxillary deficiency, increases the possibility of relapse because of limitation in anterior movement and adaptation of soft tissue. In these cases, distraction osteogenesis(DO) can be applied for stable result. We report a case of cleft lip and palate patient with narrowed maxillary arch and maxillary deficiency using self ligating bracket and DO.

• The korean journal of orthodontics
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• v.23 no.3 s.42
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• pp.319-326
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• 1993

The purpose of this study was to evaluate the frequency of congenital missing teeth and supernumerary teeth in cleft patients. The subjects were divided into bilateral cleft lip and palate(BCLP), unilateral cleft lip and palate(UCLP) and cleft palate alone(CP alone) groups. 97 cleft patients(BCLP 15, UCLP 70, CP alone 12) between 6-20 years old were evaluated. Panorama film, Orthodontic chart and initial intraoral photogram were employed for this research. The obtained results were as follows. 1. The incidence of congenital missing teeth in total cleft samples was $57.7\%$, and the incidence of supernumerary teeth was $26.8\%$. Each incidence was higher than non-cleft. 2. The incidence of congenital missing teeth was the highest in BCLP and the lowest in CP alone. 3. The number of congenital missing teeth per perso was usually one, and the frequency was higher in the maxillary lateral incisors$(67.8\%)$, and maxillary second premolar$(14.9\%)$ than other teeth. 4. Most of tooth number anomalies in cleft patients were found in maxilla, especially adjacent region to the cleft site.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.375-380
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• 2005

Furlow palatoplasty has been favored by many plastic surgeons as the primary treatment for the velopharyngeal insufficiency associated with submucous cleft palate. The purpose of this article is to introduce an efficacy of Furlow palatoplasty and speech therapy performed on patients who were diagnosed belatedly as having submucous cleft palates. From 2002 to 2004, four submucous cleft palate patients over 5 years of age with velopharyngeal insufficiency received Furlow palatoplasty. The patients were evaluated through the preoperative perceptual speech assessment, nasometry, and videonasopharyngoscopy. Postoperatively, two patients achieved competent velopharyngeal function in running speech. One of the remaining two could achieve competent velopharyngeal function with visual biofeedback speech therapy and the other could not use her new velopharyngeal function in running speech because of her age. Speech therapy can correct the articulation errors and thus improve the velopharyngeal function to a certain extent by eliminating some compensatory articulations that might have an adverse influence on velopharyngeal function. This study shows that Furlow palatoplasty can successfully correct the velopharyngeal insufficiency in submucous cleft palate patients and speech therapy has a role in reinforcing surgical result. But age is still a restrictive factor even though surgery was well done.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.6 no.1
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• pp.45-50
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• 1976

The author observed morphological change in palate development of rat embryo after irradiation of x-ray on the one side of the duplex uterus. The time-matings occured between 6 p.m. and 8 p.m. and all females with copulation plugs at 8 a.m. were isolated and properly marked for evidence of copulation. The lower left abdomen of mothers were exposed to x-radiation on the 7 1/2th, 9 1/2th, 11 1/2th day of gestation, respectively 150, 250, 350, 500rads. At 18 1/2th day of post-conception, the pregnant females were dissected and the contents of the two uteri examined. The translucent sample by Alizarin red S stain were prepared. The results were as follows; 1. The result that groups irradiated by 250rads and 350rads made marked difference in comparison with the control group suggests the x-ray to be a inducing factor of cleft palate. 2. At 11 1/2th day of gestation, incidence of cleft palate induced by x-irradiation was highest. 3. Mortality showed the highest frequency at 7 1/2th day of gestation and tended to decrease in according to increasing of age. 4. Morphology of cleft palate induced by x-irradiation showed similarity in comparison with those induced by other factors having reported ever.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.67-74
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• 2006

Palatoplasty using Furlow's double-opposing Z-plasty has been performed from June, 1995 to September, 1999 at Seoul National University Children's Hospital. The goal of this study is to determine the optimal timing of repair and cleft severity affecting velopharyngeal function. This is the retrospective study of patients operated by the second author. The mean age of patients was 10.53 months. The patients could be divided into three groups-isolated cleft palate(n=70), unilateral cleft lip and palate(n=88), and bilateral cleft lip and palate(n=42). To evaluate the velopharyngeal function, we used two parameters, speech evaluation and cineofluorography using DSR(digital subtraction radiography). Also, to determine the relevance between cleft severity and speech development, we measured the distance between maxillary tuberosities and cleft margins. Among 200 patients, about 96% had no or minimal hypernasality and 87% had no or mild nasal emission. The cleft width and length of soft palate seemed not to be related with the speech development. Palatoplasty at the age under 12 months resulted in less 'nasal emission' and better 'articulation' of the parameters that were assessed at the age of 7 years. It can be concluded Furlow palatoplasty shows satisfactory results and also it seems that it is better to perform the operation before the age of 12 months.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.2
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• pp.89-96
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• 2012

Le Fort 1 osteotomy or maxillary advancement with distraction osteogenesis (DO) is main treatment strategy for cleft palate patients with maxillary hypoplasia. Maxillary DO allows greater maxillary advancement within physiological limit than Le Fort 1 osteotomy. Moreover, it is better for velopharyngeal function. However, there is a greater tendency for an increase in nasal sound when maxilla is advanced excessively. Therefore, the advancement of anterior maxillary segment using DO has been utilized. It offers advantages such as an increase in the length of the palate, a prevention of the change in palatopharyngeal depth, and a preservation of the velopharyngeal function. Moreover, it will obliterate the necessity of bone graft, and it prevents the occurrence of oronasal or oroantral fistula. Finally, it stimulates the regeneration of the soft and hard tissue of alveolus, and subsequently makes possible to place implant.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.1
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• pp.7-20
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• 2009

Orthodontic treatment planning of cleft lip and palate requires consideration of the characteristic features, growth pattern and functional disorders related to cleft lip and palate patients. Tissue deficiencies and constriction of the scar tissue in surgically treated cleft lip and palate results in disturbance of maxillary growth and deficiency of midfacial region with anterior and posterior crossbite. These patients often present congenital missing of teeth, supernumerary teeth, malformed teeth, or ectopic position of teeth, which should be treated by orthodontic treatment by expanding upper arch followed by fixed appliance. Proper use of retainer and continuous follow-up is needed to prevent relapse after orthodontic treatment has finished. Also we have to pay attention to correct speech disorder which is caused by the velopharyngeal insufficiency.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.483-488
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• 2006

Velopharyngeal function refers to the combined activity of the soft palate and pharynx in closing and opening the velopharyngeal port to the required degree. In normal speech, various muscles of palate & pharynx function as sphincter and occlude the oropharynx from the nasopharynx during the production of oral consonant sounds. Inadequate velopharyngeal function caused by neurologic disorder - cerebral apoplexy, regressive diseases - disseminated sclerosis, Parkinson's disease, congenital deformity - cleft palate, cerebral palsy and etc. may result in abnormal speech characterized by hypernasality, nasal emission and decreased intelligibility of speech due to weak consonant production. In our study, we constructed speech aids prosthesis - Speech bulb in the incomplete cleft palate VPI patient with hypernasality and assessed velopharyngeal function with nasometer which can evaluate the speech characteristics objectively.