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

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

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.

Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation

OBJECTIVE

To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area.

DESIGN

Methodological study.

PARTICIPANTS AND METHODS

Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models.

RESULTS

There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model.

CONCLUSION

Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.

Anatomical Study of Domain Rescue of Palatal Length in Patients With a Wide Cleft Palate: Buccal Flap Reconstruction in Primary Palatoplasty

BACKGROUND

This study characterizes the potential loss of velar length in patients with a wide cleft and rescue of this loss of domain by local flap reconstruction, providing anatomic evidence in support of primary lengthening of the soft palate during palatoplasty.

METHODS

A retrospective review was conducted of all patients with a cleft palate at least 10mm in width, who underwent primary palatoplasty with a buccal flap prior to 18 months of age over a 2-year period. All patients underwent primary palatoplasty with horizontal transection of the nasal mucosa, which was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting palatal lengthening was measured and the mucosal defect was reconstructed with a buccal flap.

RESULTS

Of the 22 patients included, 3 (13.6%) had a history of Pierre Robin sequence, and 5 (22.7%) had an associated syndrome. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 had (13.6%) a Veau IV cleft. All patients had a right buccal flap during primary palatoplasty. The mean cleft width at the posterior nasal spine was 10.6  ±  2.82mm, and mean lengthening of the velum after horizontal transection of the nasal mucosa closure was 10.5  ±  2.23mm. There were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission, and no bleeding complications.

CONCLUSIONS

Patients with a wide cleft palate have a potential loss of 1cm velar length. The buccal flap can rescue the loss of domain in palatal length, and potentially improve palatal excursion.

Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings

A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case-control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes.

Facial grimace during speech in cleft lip and palate: a proposal for classification

PURPOSE

To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC).

METHODS

Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient.

RESULTS

In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages.

CONCLUSION

The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.

A Living Cell Repository of the Cranio-/Orofacial Region to Advance Research and Promote Personalized Medicine

The prevalence of congenital anomalies in newborns is estimated to be as high as 6%, many of which involving the cranio-/orofacial region. Such malformations, including several syndromes, are usually identified prenatally, at birth, or rarely later in life. The lack of clinically relevant human cell models of these often very rare conditions, the societal pressure to avoid the use of animal models and the fact that the biological mechanisms between rodents and human are not necessarily identical, makes studying cranio-/orofacial anomalies challenging. To overcome these limitations, we are developing a living cell repository of healthy and diseased cells derived from the cranio-/orofacial region. Ultimately, we aim to make patient-derived cells, which retain the molecular and genetic characteristics of the original anomaly or disease in vitro, available for the scientific community. We report our efforts in establishing a human living cell bank derived from the cranio-/orofacial region of otherwise discarded tissue samples, detail our strategy, processes and quality checks. Such specific cell models have a great potential for discovery and translational research and might lead to a better understanding and management of craniofacial anomalies for the benefit of all affected individuals.

A Novel Van der Woude Syndrome-Causing IRF6 Variant Is Subject to Incomplete Non-sense-Mediated mRNA Decay Affecting the Phenotype of Keratinocytes

Van der Woude syndrome (VWS) is a genetic syndrome that leads to typical phenotypic traits, including lower lip pits and cleft lip/palate (CLP). The majority of VWS-affected patients harbor a pathogenic variant in the gene encoding for the transcription factor interferon regulatory factor 6 (IRF6), a crucial regulator of orofacial development, epidermal differentiation and tissue repair. However, most of the underlying mechanisms leading from pathogenic IRF6 gene variants to phenotypes observed in VWS remain poorly understood and elusive. The availability of one VWS individual within our cohort of CLP patients allowed us to identify a novel VWS-causing IRF6 variant and to functionally characterize it. Using VWS patient-derived keratinocytes, we reveal that most of the mutated IRF6_VWS transcripts are subject to a non-sense-mediated mRNA decay mechanism, resulting in IRF6 haploinsufficiency. While moderate levels of IRF6_VWS remain detectable in the VWS keratinocytes, our data illustrate that the IRF6_VWS protein, which lacks part of its protein-binding domain and its whole C-terminus, is noticeably less stable than its wild-type counterpart. Still, it maintains transcription factor function. As we report and characterize a so far undescribed VWS-causing IRF6 variant, our results shed light on the physiological as well as pathological role of IRF6 in keratinocytes. This acquired knowledge is essential for a better understanding of the molecular mechanisms leading to VWS and CLP.

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

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.

Orofacial functions and quality of life in children with unilateral cleft lip and palate

This study aimed to evaluate the orofacial functions and oral health-related quality of life (OHRQoL) of children with unilateral cleft lip and palate (UCLP). This case-control study included patients with UCLP matched by sex and age with controls (children without UCLP), resulting in the inclusion of a total of 108 eight- to ten-year-old children. Orofacial functions and OHRQoL were evaluated using the Nordic Orofacial Test-Screening (NOT-S) and the Child Perceptions Questionnaire (CPQ 8-1 0 ), respectively. Data normality was assessed by the Kolmogorov-Smirnov test. Differences and correlations in NOT-S and CPQ 8-1 0 scores between and within the groups were evaluated using Mann-Whitney and Spearman´s correlation tests, respectively. The distribution of NOT-S and global ratings of CPQ 8-1 0 for each group were assessed by Chi-squared/Fisher's Exact tests. The UCLP group had a higher NOT-S total and examination scores than the controls. Dysfunctions related to breathing, facial symmetry/expression, and speech were more frequent in the UCLP patients than in the controls. The UCLP group had higher scores on the social well-being domain than the controls. There was a significant difference between the groups in their ratings in regards to the extent to which their oral condition affected their life overall, with controls perceiving it as somewhat better than patients. In both groups, NOT-S total and interview scores were positively correlated with CPQ 8-1 0 total and domain scores. The NOT-S examination score was only significantly correlated with social domain scores in the control group. The presence of UCLP was associated with clinical signs of orofacial dysfunctions related to breathing, facial symmetry/expression, and speech. Children with UCLP reported more orofacial dysfunctions and negative impacts on social well-being than controls.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Objective:

The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development.

Design:

Systematic review.

Setting:

Various primary cleft and craniofacial centers in the world.

Patients, Participants:

Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery.

Intervention:

Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports.

Outcome:

The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty.

Results:

The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor.

Conclusion:

Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis

Background:

Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate.

Methods:

A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged.

Results:

A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34).

Conclusions:

The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.

Perfil da fala de pacientes submetidos à palatoplastia primária

RESUMO Objetivo caracterizar o perfil e a fala de pacientes submetidos à palatoplastia primária em um hospital escola de São Paulo, levando-se em consideração a idade do paciente no momento da cirurgia (precoce até os 2 anos de idade e tardio após 2 anos). Método 97 indivíduos, de ambos os gêneros, com diagnóstico de fissura de palato associada ou não à de lábio, divididos em dois grupos: 1) grupo precoce (GP), composto por 43 indivíduos operados até o segundo ano de vida; 2) grupo tardio (GT), composto por 54 indivíduos operados após o segundo ano. Os participantes foram submetidos à avaliação clínica fonoaudiológica. Os parâmetros avaliados e considerados para o estudo foram: classificação da ressonância, presença de ronco nasal audível, ocorrência de fraca pressão intraoral, ocorrência de emissão nasal, classificação da inteligibilidade de fala e presença de distúrbios articulatórios compensatórios (DACs). Uma porcentagem randomicamente selecionada de participantes (30%) foi reavaliada por mais duas fonoaudiólogas e a comparação entre os juízes indicou alta concordância. Resultados (nível de significância de 5%): os grupos não se diferenciaram em relação à classificação da ressonância (p=0,067), grau de hipernasalidade (p=0,113), presença de ronco nasal (p=0,179), ocorrência de fraca pressão intraoral (p=0,152), ocorrência de emissão nasal (p=0,369) e classificação da inteligibilidade de fala (p=0,113). Em relação à presença de DACs, os grupos se diferenciaram (p=0,020), com maior ocorrência de fonemas alterados no GT. Conclusão foi possível caracterizar o perfil geral e de fala dos pacientes submetidos à palatoplastia primária do referido hospital escola. Concluiu-se que a realização da cirurgia precocemente traz melhores resultados em relação à fala.

Occlusal, chewing, and tasting characteristics associated with orofacial dysfunctions in children with unilateral cleft lip and palate: a case-control study

OBJECTIVE

The objective of this study is to assess the associations between orofacial dysfunctions with malocclusion, masticatory performance, and taste in children with and without unilateral cleft lip and palate (UCLP).

MATERIAL AND METHODS

A patient-based, matched, case-control study was conducted involving 108 8- to 10-year-old children divided in UCLP and control groups. Orofacial dysfunctions were evaluated using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need was evaluated using the Goslon Yardstick Index (GYI) and the Index of Orthodontic Treatment Need (IOTN) of patients and controls, respectively. Masticatory performance was assessed using a chewable test material to determine median particle size (X ₅₀) and distribution of particles in different sieves (b value). Taste perception was evaluated using four solutions (sweet, salty, bitter, or acid) in three different concentrations.

RESULTS

More than half of the patients needed orthodontic surgery. UCLP group presented higher median particle size and needed more chewing cycles to comminute the artificial test into particles smaller than the median than those of controls. UCLP group had less perception of salty flavor than controls. There was a positive correlation between b value and NOT-S examination score for patients. In regression analysis, a significant interrelationship was observed between NOT-S examination score and b value.

CONCLUSIONS

In the UCLP patients, masticatory performance was compromised probably as a result of facial asymmetry and speech disturbance; whereas, taste was less perceived only for salty flavor.

CLINICAL RELEVANCE

These findings provide preliminary evidence that mastication and taste are altered in children with UCLP, so these factors must be followed up to ensure oral and general health in growing individuals.

Original article. Articulation disorders and patterns in children with a cleft

Background: Compensatory articulation disorders (CAD) are the most common speech defects in patients with a cleft. Early prevention programs are needed to avoid CAD.

Objectives: To examine articulation disorders, patterns, and related speech outcomes in children with a cleft palate with or without lip defects.

Methods: Articulation test record forms and clinical records of 42 children were accessed retrospectively to provide the data of speech outcomes related to cleft palate. Double data entries and incorrect completion type errors were corrected.

Results: Prevalence of articulatory defects was 88% (functional articulation disorders, 12%; compensatory articulation disorders, 10%; functional articulation disorders and CAD, 67%), resonance disorder was 50%, and voice abnormalities was 19%. Abnormal backing of oral consonants, particularly glottal substitution was the most common pattern of CAD (40%), follow by velar substitution (36%), and nasal consonant for oral pressure consonant (21%). There was high incidence of functional articulation disorder in patients with a cleft (76%). Younger children (≤7 years old) had more articulation defects than older children (>7 years old) (mean difference = 3.308, P = 0.002, 95% confident interval 1.683-6.971). Levene’s test for equal variance found that resonance disorder seems unaffected by the number of articulation errors (mean difference = 0.253, P = 0.897, 95% confident interval -3.736-4.241).

Conclusion: CAD, particularly abnormal backing of oral consonants and hypernasality were the most common speech defects in children with cleft. Refinement and revision of timing for referring for early speech intervention should be reconsidered.

Speech in 10-Year-Olds Born with Cleft Lip and Palate: What Do Peers Say?

Objective

The aim of this study was to explore how 10-year-olds describe speech and communicative participation in children born with unilateral cleft lip and palate in their own words, whether they perceive signs of velopharyngeal insufficiency (VPI) and articulation errors of different degrees, and if so, which terminology they use.

Methods/Participants

Nineteen 10-year-olds participated in three focus group interviews where they listened to 10 to 12 speech samples with different types of cleft speech characteristics assessed by speech and language pathologists (SLPs) and described what they heard. The interviews were transcribed and analyzed with qualitative content analysis.

Results

The analysis resulted in three interlinked categories encompassing different aspects of speech, personality, and social implications: descriptions of speech, thoughts on causes and consequences, and emotional reactions and associations. Each category contains four subcategories exemplified with quotes from the children's statements. More pronounced signs of VPI were perceived but referred to in terms relevant to 10-year-olds. Articulatory difficulties, even minor ones, were noted. Peers reflected on the risk to teasing and bullying and on how children with impaired speech might experience their situation. The SLPs and peers did not agree on minor signs of VPI, but they were unanimous in their analysis of clinically normal and more severely impaired speech.

Conclusions

Articulatory impairments may be more important to treat than minor signs of VPI based on what peers say.

Five-year speech and language outcomes in children with cleft lip-palate

OBJECTIVE

To investigate 5-year speech and language outcomes in children with cleft lip/palate (CLP).

MATERIALS AND METHODS

Thirty-eight children aged 4-7 years and 8 months were recruited for this study. Speech abilities including articulation, resonance, voice, and intelligibility were assessed based on Thai Universal Parameters of Speech Outcomes. Language ability was assessed by the Language Screening Test.

RESULTS

The findings revealed that children with clefts had speech and language delay, abnormal understandability, resonance abnormality, and voice disturbance; articulation defects that were 8.33 (1.75, 22.47), 50.00 (32.92, 67.08), 36.11 (20.82, 53.78), 30.56 (16.35, 48.11), and 94.44 (81.34, 99.32).

CONCLUSIONS

Articulation errors were the most common speech and language defects in children with clefts, followed by abnormal understandability, resonance abnormality, and voice disturbance. These results should be of critical concern. Protocol reviewing and early intervention programs are needed for improved speech outcomes.

Subjective outcomes after treatment for velopharyngeal dysfunction

BACKGROUND

Velopharyngeal dysfunction (VPD) can have various causes and may be a significant disability for the affected patient. Treatment options include surgery and speech therapy, but the success rates are often inconsistent.

METHODS

In this study, self-assessment questionnaires were sent out to 222 Swedish patients with VPD. The questionnaire included questions about satisfaction with speech, perceived speech quality, perceived improvement from VPD-surgery, and/or speech therapy. Out of 117 (52.7%) respondents, 114 (51.4%) patients were included in the study. The participants were 7-71 years of age (median = 14 years), diagnosed with cleft palate, neurological/developmental delay, congenital hypernasality, or acquired VPD. All patients had previously undergone videofluoroscopy, and 61.4% had undergone VPD-surgery.

RESULTS

Seventy-one per cent of the patients perceived their speech to be normal or slightly deviant, but only 55% were satisfied with their speech. Sixty per cent of the operated on patients felt that the treatment had improved their speech much or very much, 10% thought that they had moderate improvement, and 30% stated that they had no or little improvement. Out of the patients that had received speech therapy, 41% felt that the treatment had improved their speech much or very much, 21% thought that they had moderate improvement, and 33% stated that they had no or little improvement.

CONCLUSION

In conclusion, most patients with VPD in this study who underwent evaluation and treatment felt that surgery and speech therapy had improved their speech, but only about half of them were in the end satisfied with the quality of their speech.

Speech outcomes at age 5 and 10 years in unilateral cleft lip and palate after one-stage palatal repair with minimal incision technique - a longitudinal perspective

OBJECTIVES

To investigate speech outcomes in 5- and 10-year-old children with unilateral cleft lip and palate (UCLP) treated according to minimal incision technique (MIT) - a one-stage palatal method.

METHODS

A retrospective, longitudinal cohort study of a consecutive series of 69 patients born with UCLP, treated with MIT (mean age 13 months) was included. Forty-two children (43%) received a velopharyngeal flap; 12 before 5 years and another 18 before 10 years of age. Cleft speech variables were rated from standardized audio recordings at 5 and 10 years of age, independently by three experienced, external speech-language pathologists, blinded to the material. The prevalences of cleft speech characteristics were determined, and inter- and intra-rater agreement calculated.

RESULTS

More than mild hypernasality, weak pressure consonants and perceived incompetent velopharyngeal function were present in 19-22% of the children at 5 years, but improved to less than 5% at 10 years. However, audible nasal air leakage, prevalent in 23% at 5 years, did not improve by age 10. Thirty percent had frequent or almost always persistent compensatory articulation at 5 years, and 6% at age 10. The general impression of speech improved markedly, from 57% giving a normal impression at 5 years to 89% at 10 years. A high prevalence of distorted/s/was found at both 5 and 10 years of age.

CONCLUSIONS

A high occurrence of speech deviances at 5 years of age after MIT was markedly reduced at 10 years in this study of children with unilateral cleft lip and palate. The high pharyngeal flap rate presumably accounted for the positive speech development.

Prevalence and types of articulation errors in Saudi Arabic-speaking children with repaired cleft lip and palate

OBJECTIVES

The purpose of this study was to assess prevalence and types of consonant production errors and phonological processes in Saudi Arabic-speaking children with repaired cleft lip and palate, and to determine the relationship between frequency of errors on one hand and the type of the cleft. Possible relationship between age, gender and frequency of errors was also investigated.

METHODS

Eighty Saudi children with repaired cleft lip and palate aged 6-15 years (mean 6.7 years), underwent speech, language, and hearing evaluation. The diagnosis of articulation deficits was based on the results of an Arabic articulation test. Phonological processes were reported based on the productivity scale of a minimum 20% of occurrence. Diagnosis of nasality was based on a 5-point scale that reflects severity from 0 through 4. All participants underwent intraoral examination, informal language assessment, and hearing evaluation to assess their speech and language abilities. The Chi-Square test for independence was used to analyze the results of consonant production as a function of type of CLP and age.

RESULTS

Out of 80 participants with CLP, 21 participants had normal articulation and resonance, 59 of participants (74%) showed speech abnormalities. Twenty-one of these 59 participants showed only articulation errors; 17 showed only hypernasality; and 21 showed both articulation and resonance deficits. CAs were observed in 20 participant. The productive phonological processes were consonant backing, final consonant deletion, gliding, and stopping. At age 6 and older, 37% of participants had persisting hearing loss.

CONCLUSIONS

Despite early age at time of surgery (mean 6.7 months) for the studied CLP participants in this study, a substantial number of them demonstrated articulation errors and hypernasality. The results showed desirable findings for diverse languages. It is especially interesting to consider the prevalence of glottal stops and pharyngeal fricatives in a population for whom these sound are phonemic.

Speech outcome in complete unilateral cleft lip and palate - a comparison of three methods of the hard palate closure

The aim of this study was to compare the speech in subjects with cleft lip and palate, in whom three methods of the hard palate closure were used. One hundred and thirty-seven children (96 boys, 41 girls; mean age = 12 years, SD = 1·2) with complete unilateral cleft lip and palate (CUCLP) operated by a single surgeon with a one-stage method were evaluated. The management of the cleft lip and soft palate was comparable in all subjects; for hard palate repair, three different methods were used: bilateral von Langenbeck closure (b-vL group, n = 39), unilateral von Langenbeck closure (u-vL group, n = 56) and vomerplasty (v-p group, n = 42). Speech was assessed: (i) perceptually for the presence of a) hypernasality, b) compensatory articulations (CAs), c) audible nasal air emissions (ANE) and d) speech intelligibility; (ii) for the presence of compensatory facial grimacing, (iii) with clinical intra-oral evaluation and (iv) with videonasendoscopy. A total rate of hypernasality requiring pharyngoplasty was 5·1%; total incidence post-oral compensatory articulations (CAs) was 2·2%. The overall speech intelligibility was good in 84·7% of cases. Oronasal fistulas (ONFs) occurred in 15·7% b-vL subjects, 7·1% u-vL subjects and 50% v-p subjects (P < 0·001). No statistically significant intergroup differences for hypernasality, CAs and intelligibility were found (P > 0·1). In conclusion, the speech after early one-stage repair of CUCLP was satisfactory. The method of hard palate repair affected the incidence of ONFs, which, however, caused relatively mild and inconsistent speech errors.