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Peterson P, Nyberg J, Persson C, Mark H, Lohmander A. Speech Outcome and Self-Reported Communicative Ability in Young Adults Born With Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair. Cleft Palate Craniofac J 2021; 59:751-764. [PMID: 34263653 DOI: 10.1177/10556656211025926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare with normative data on individuals without cleft lip and palate and to study the relationship between patients' and experts' judgments. DESIGN A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients. MAIN OUTCOME MEASURE(S) Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age. RESULTS No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct [PCC]) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility (rs = 0.436, P < .01), PCC (rs = -0.534, P < .01), and correct /s/ (rs = -0.354, P < .05). CONCLUSIONS No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.
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Affiliation(s)
- Petra Peterson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Stockholm Craniofacial Team, Medical Unit of Craniofacial Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Christina Persson
- Division of Speech and Language Pathology, Institute of Neuroscience and Rehabilitation, Sahlgrenska Academy of Gothenburg University, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Speech-Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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Nyberg J, Neovius E, Lohmander A. Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate. J Plast Surg Hand Surg 2017; 52:20-29. [DOI: 10.1080/2000656x.2017.1316282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Functional Area Speech & Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech & Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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Arshad AI, Alam MK, Khamis MF. Assessment of complete unilateral cleft lip and palate patients: Determination of factors effecting dental arch relationships. Int J Pediatr Otorhinolaryngol 2017; 92:70-74. [PMID: 28012538 DOI: 10.1016/j.ijporl.2016.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of the current study was to assess the treatment outcome of non-syndromic patients having complete unilateral cleft lip and palate (CUCLP) by using GOSLON index and to determine any association of pre and/or postnatal factors with the treatment outcome. MATERIALS AND METHODS One hundred and one sets of dental models of patients having CUCLP were assessed in this retrospective study. Five examiners that were blinded to case-specific information scored the dental models at two instances with an interval of two weeks to ensure memory bias elimination (5 × 101 × 2 = 1010 observations). Calibration courses were conducted prior to scoring and each examiner was provided with scoring sheets, pictures of GOSLON reference models and flowcharts explaining the scoring method. RESULTS According to GOSLON index, a mean (SD) GOSLON score of 3.04 (1.25) was determined. Based on treatment outcome groups, 62 patients had favorable (grade 1, 2, and 3) and 39 cases had unfavorable (grade 4 and 5) treatment outcome. Chi-square tests revealed a significant association of gender (P = 0.002), cheiloplasty (P = 0.001) and palatoplasty (P < 0.001) with the treatment outcome. These associations were further explored by entering five independent variables in the logistic regression models. CONCLUSIONS The current study found an intermediate treatment outcome of CUCLP cases using GOSLON index. Final logistic model showed that gender, cheiloplasty, and palatoplasty had significantly higher odds of influencing outcomes. Identification of these factors provides us an evidence of traditional and outdated surgical methods and encourages clinicians to adopt current techniques to improve treatment outcomes. This implementation will facilitate comparison between the traditional and current techniques of primary surgical repair.
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Affiliation(s)
- Anas Imran Arshad
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | | | - Mohd Fadhli Khamis
- Forensic Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg 2014; 134:618e-627e. [PMID: 25357056 DOI: 10.1097/prs.0000000000000548] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of an oronasal fistula after primary cleft palate repair has a wide variation reported in the literature. The aim of this review is to identify the reported oronasal fistula incidence to provide a benchmark for surgical practice. METHODS A systematic review was undertaken to investigate the incidence of fistula. Multiple meta-analyses were performed to pool proportions of reported fistulae, in each data set corresponding to the continent of origin of the study, type of cleft, and techniques of cleft palate repair used. RESULTS A total of 9294 patients were included from 44 studies. The overall incidence of reported fistula was 8.6 percent (95 percent CI, 6.4 to 11.1 percent). There was no significant difference in the fistula incidence corresponding to the continent of origin of each study or the repair technique used. The incidence of fistula in cleft lip-cleft palate was 17.9 percent, which was significantly higher (p = 0.03) than in cases of cleft palate alone (5.4 percent). CONCLUSIONS Palatal fistulae were more likely to occur in cases of combined cleft lip-cleft palate, compared with cleft palate alone. The authors would recommend the prospective examination and recording of all fistulae to a standardized classification scheme. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Lithovius RH, Ylikontiola LP, Sándor GKB. Incidence of palatal fistula formation after primary palatoplasty in northern Finland. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:632-6. [PMID: 25283164 DOI: 10.1016/j.oooo.2014.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to determine the incidence of palatal fistulas after primary cleft palate repair. STUDY DESIGN The study included 136 patients who were treated at the Oulu University Hospital cleft lip and palate center between 1998 and 2011. All patients were treated by the same surgeons with 1-stage palatoplasty closing the hard and soft palate concurrently. RESULTS The overall frequency of postoperative fistula was 9.6% of patients. Patients with cleft lip and palate (20.0%) were more likely to develop postoperative palatal fistulas than patients with cleft palate (6.6%). Surgical technique and cleft severity were not significant factors for the development of palatal fistulas. CONCLUSIONS The majority of patients undergoing primary palatal repair do not develop palatal fistulas.
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Affiliation(s)
- Riitta H Lithovius
- PhD candidate, Institute of Dentistry, University of Oulu, Oulu, Finland
| | - Leena P Ylikontiola
- Director of Cleft Lip and Palate Program, Oulu University Hospital, Institute of Dentistry, University of Oulu, Oulu, Finland
| | - George K B Sándor
- Professor of Oral and Maxillofacial Surgery, University of Oulu; Consultant, Oulu University Hospital; Professor of Tissue Engineering, BioMediTech, Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland.
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Landheer JA, Breugem CC, van der Molen ABM. Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure. Cleft Palate Craniofac J 2014; 47:623-30. [PMID: 21039279 DOI: 10.1597/09-069] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review the clinical outcomes of our cleft palate team in terms of fistula rate and to determine whether gender, syndrome, cleft type, age at repair, operating surgeon, type of cleft repair, and cleft width influence the risk of fistula occurrence. Cleft palate repair was done in one- or two-stages. DESIGN A retrospective analysis was performed of medical records of 275 patients who underwent palate repair and who were born between 1988 and 1997. All consecutive cleft (lip and) palate patients (including syndromes) were incorporated. Multivariate analysis was performed to look for predictors of the formation of fistulas. RESULTS One hundred fifty-four and 121 patients underwent two-stage and one-stage repair, respectively. The median duration of follow-up was 9 years. The overall incidence of the formation of a fistula was 21%, with a recurrence rate of 9% after fistula repair. Three independent predictors of fistulization were found: palate repair in two stages, younger age at the second stage of a two-stage repair (≤3.0 years), and greater cleft width (≥13 mm). A fistula occurred in 27% of two-stage repairs versus 14% of one-stage repairs. CONCLUSIONS This study found a relatively high incidence of fistula formation after cleft palate repair. Although the study populations were not randomized, this study suggests that a two-stage closure has a higher rate of fistula formation when compared with a one-stage closure. This study demonstrates that cleft width at the time of cleft palate repair plays a crucial role in the development of fistulas.
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Affiliation(s)
- J A Landheer
- Utrecht Medical Center, Utrecht, The Netherlands
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Mani M, Reiser E, Andlin-Sobocki A, Skoog V, Holmström M. Factors Related to Quality of Life and Satisfaction with Nasal Appearance in Patients Treated for Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2013; 50:432-9. [DOI: 10.1597/11-035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify factors related to quality of life (QoL) and satisfaction with nasal appearance among patients treated for unilateral cleft lip and palate (UCLP). Design Cross-sectional population study with long-term follow-up. Patients/Settings All patients with UCLP born between 1960 and 1987, treated at Uppsala University Hospital, were invited (n = 109); 86 (79%) participated. Mean follow-up time was 35 years. Main Outcome Measures Quality of life was measured with Short Form–36 (SF-36) and analyzed using mental and physical cluster scores (MCS and PCS). Nasal appearance was self-assessed with the “Satisfaction With Appearance” questionnaire and by panel judgment. Multivariate regression analyses explored endogenous factors (age, gender, infancy cleft width, nasal function, nasolabial appearance) and exogenous factors (marital status, number of children, education level, operation method, number of rhinoplasties performed). Results A larger cleft width in infancy was associated with less satisfaction with nasal appearance as adults. A lower mental health QoL was associated with less satisfaction with nasal appearance. Despite female gender being linked to less satisfaction with nasal appearance, it was associated with higher mental health QoL. Higher resistance during nasal breathing was associated with lower physical health QoL. Conclusions Gender and infant cleft width may affect QoL and satisfaction with nasal appearance among adults. They are potential predictive factors for satisfaction with nasal appearance and QoL during adulthood. The correlation of nasal function impairment and decreased physical health QoL underlines the importance of treatment of nasal symptoms in these patients.
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Affiliation(s)
- Maria Mani
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Erika Reiser
- Orthodontics, Department of Maxillofacial Surgery and Orthodontics, University Hospital, Uppsala, Sweden
| | - Anna Andlin-Sobocki
- Department of Maxillofacial Surgery and Orthodontics, Uppsala University Hospital, Uppsala, Sweden
- Orthodontics of the Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Valdemer Skoog
- Cleft Lip and Palate, Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Holmström
- Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
- Senior Consultant, Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
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Buyu Y, Manyama M, Chandika A, Gilyoma J. Orofacial Clefts at Bugando Medical Centre: Associated Factors and Postsurgical Complications. Cleft Palate Craniofac J 2012; 49:736-40. [DOI: 10.1597/10-202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine factors associated with orofacial clefts and postsurgical complications of cleft lip and palate repair surgeries in northwestern Tanzania. Methods This was a cohort study involving patients with orofacial clefts. Associated factors (family history of orofacial clefts, maternal use of alcohol and cigarette smoking during pregnancy) were obtained through interviews with accompanying parents. Antenatal cards were used to obtain maternal age at birth and birth weight. Results Ninety-four patients with different orofacial clefts were seen. Among them, 46.8% (44/94), 13.8% (13/94), and 39.4% (37/94) had cleft lip, cleft palate, and cleft lip and palate, respectively. About 15% of orofacial cleft cases had a positive family history of orofacial clefts. Among these, 7.4% had an affected relative on the maternal side, 4.3% had an affected relative on the paternal side, and 3.2% had an affected sibling. This difference was statistically significant (chi-square = 27.7, p < .001). Orofacial cleft was significantly associated with order of birth (chi-square = 21.0, p < .001). Postoperative complications observed included palatal fistula and philtrum dehiscence. Conclusion Family history of orofacial clefts and order of birth were significantly associated with orofacial clefts in northwestern Tanzania. These factors have been associated with risk of orofacial clefts elsewhere and suggest a hereditary role in the etiology of orofacial cleft. Palatal fistula and philtrum dehiscence were postsurgical complications observed in orofacial clefts patients who had primary surgery past the recommended age. These complications could have resulted from delayed surgery and absence of presurgical procedures.
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Affiliation(s)
- Yunus Buyu
- Bugando Medical Centre, Mwanza, Tanzania
| | - Mange Manyama
- Department of Human Anatomy, Bugando University College of Health Sciences, Mwanza, Tanzania
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Borzabadi-Farahani A, Groper JN, Tanner AM, Urata MM, Panossian A, Yen SLK. The Nance Obturator, a New Fixed Obturator for Patients with Cleft Palate and Fistula. J Prosthodont 2012; 21:400-3. [DOI: 10.1111/j.1532-849x.2012.00853.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Havstam C, Laakso K, Lohmander A, Ringsberg KC. Taking Charge of Communication: Adults' Descriptions of Growing up with a Cleft-Related Speech Impairment. Cleft Palate Craniofac J 2011; 48:717-26. [DOI: 10.1597/10-033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To obtain descriptions of the experience of growing up with a cleft-related speech impairment and how it was dealt with. Design Semistructured interviews were tape-recorded, transcribed verbatim, and analyzed using a qualitative approach inspired by grounded theory methodology. Setting Interviews took place at participants' homes or workplaces or at the university. Participants Thirteen young adults (25 to 34 years of age) born with cleft palate with or without cleft lip. Results The analysis resulted in the core category Taking charge of communication, which comprised three main categories: Forming an idea of one's speech, Learning about one's communication, and Taking responsibility for communication. The first main category was made up of three subcategories and the other two had two. The categories emerged as parallel processes in the understanding and active handling of communicative interaction. Conclusions The participants described the processes that had enabled them to take charge of their communication. Seeing things from the listener's perspective and being open about the cleft and the speech disorder emerged as important parts of taking active responsibility for communication, as well as accepting their present speech and communication. Communicative participation should be assessed more thoroughly to understand the individual needs of people born with a cleft who have a speech impairment into adolescence.
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Affiliation(s)
- Christina Havstam
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katja Laakso
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anette Lohmander
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, Sahlgrenska Academy at University of Gothenburg and CLINTEC, Division of Speech and Language Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Andersson EM, Sandvik L, Tørdal IB, Åbyholm F. Pharyngoplasty after primary repair of clefts of the secondary palate. J Plast Surg Hand Surg 2010; 44:26-30. [DOI: 10.3109/02844310903259066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Ruiter A, van der Bilt A, Gert M, Ronald K. Orthodontie Treatment Results following Grafting Autologous Mandibular Bone to the Alveolar Cleft in Patients with a Complete Unilateral Cleft. Cleft Palate Craniofac J 2010; 47:35-42. [DOI: 10.1597/08-095.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze orthodontic treatment results following mandibular symphysis bone grafting and postoperative orthodontic treatment. Design Randomized selection of 75 patients out of 308 with unilateral cleft of lip, alveolus, and palate, operated upon according to protocol between 1990 and 2008 in the Wilhelmina Children's Hospital, Utrecht, The Netherlands. Main Outcome Measure Goslon Yardstick rating changes of dental arch relationship. Significant agreement ( p < .001) was observed between the two assessments carried out with an interval of 3 months (Cohen's kappa = .963, p < .001). Results Following mandibular bone grafting and orthodontic treatment in 65.3% of the patients, the aim of treatment (Goslon Yardstick groups 1 and 2) had been achieved. The applied before/after Goslon allocations showed high improvement significance ( p < .001). Conclusions Postoperative orthodontic treatment in patients following grafting with mandibular symphysis bone showed excellent results.
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Affiliation(s)
- Ad de Ruiter
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands, and private practice, Harlingen, The Netherlands
| | - Andries van der Bilt
- Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Meijer Gert
- Department of Oral and Maxillofacial Surgery, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Koole Ronald
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Farzaneh F, Becker M, Peterson AM, Svensson H. Speech results in adult Swedish patients born with bilateral complete cleft lip and palate. ACTA ACUST UNITED AC 2009; 43:207-13. [DOI: 10.1080/02844310903040722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Havstam C, Lohmander A, Dahlgren Sandberg A, Elander A. Speech and satisfaction with outcome of treatment in young adults with unilateral or bilateral complete clefts. ACTA ACUST UNITED AC 2009; 42:182-9. [DOI: 10.1080/02844310802055102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Henriksson TG, Hakelius M, Andlin-Sobocka A, Svanholm H, Low A, Skoog V. Intravelar veloplasty reinforced with palatopharyngeal muscle: A review of a 10-year consecutive series. ACTA ACUST UNITED AC 2009; 39:277-82. [PMID: 16320403 DOI: 10.1080/02844310410004874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe a technique by which the intravelar veloplasty was reinforced by including the superior part of posterior pillars and their palatopharyngeal muscle sheet in patients with cleft lip and palate. Our aim was to increase the functional length and strength of the velum and to reduce nasal emission and the need for pharyngeal flaps. Since 1990 more than 200 patients have been operated on in this way at Uppsala University Hospital. This is a retrospective follow-up of 162 consecutive patients operated on by two senior surgeons between 1990 and 2000. We describe the technique, timing, and operative observations as well as the outcome and the need for revision of the palatoplasty in some cases because of complications. To facilitate speech, 21 patients born between 1990 and 1997 (16%) were provided with a pharyngeal flap.
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Farzaneh F, Becker M, Peterson AM, Svensson H. Speech results in adult Swedish patients born with unilateral complete cleft lip and palate. ACTA ACUST UNITED AC 2009; 42:7-13. [DOI: 10.1080/02844310701694522] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Speech prognosis and need of pharyngeal flap for non syndromic vs syndromic Pierre Robin Sequence. J Pediatr Surg 2008; 43:668-74. [PMID: 18405714 DOI: 10.1016/j.jpedsurg.2007.09.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 09/12/2007] [Accepted: 09/14/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate speech outcome and need of a pharyngeal flap in children born with nonsyndromic Pierre Robin Sequence (nsPRS) vs syndromic Pierre Robin Sequence (sPRS). METHODS Pierre Robin Sequence was diagnosed when the triad microretrognathia, glossoptosis, and cleft palate were present. Children were classified at birth in 3 categories depending on respiratory and feeding problems. The Borel-Maisonny classification was used to score the velopharyngeal insufficiency. RESULTS The study was based on 38 children followed from 1985 to 2006. For the 25 nsPRS, 9 (36%) pharyngeal flaps were performed with improvements of the phonatory score in the 3 categories. For the 13 sPRS, 3 (23%) pharyngeal flaps were performed with an improvement of the phonatory scores in the 3 children. There was no statistical difference between the nsPRS and sPRS groups (P = .3) even if we compared the children in the 3 categories (P = .2). CONCLUSIONS Children born with nsPRS did not have a better prognosis of speech outcome than children born with sPRS. Respiratory and feeding problems at birth did not seem to be correlated with speech outcome. This is important when informing parents on the prognosis of long-term therapy.
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de Buys Roessingh AS, Cherpillod J, Trichet-Zbinden C, Hohlfeld J. Speech Outcome After Cranial-Based Pharyngeal Flap in Children Born With Total Cleft, Cleft Palate, or Primary Velopharyngeal Insufficiency. J Oral Maxillofac Surg 2006; 64:1736-42. [PMID: 17113439 DOI: 10.1016/j.joms.2005.11.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 07/15/2005] [Accepted: 11/14/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to compare the effect of a cranial-based pharyngeal flap on the speech of children born with a unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), cleft palate (CP), or primary velopharyngeal insufficiency (VPI) without cleft. PATIENTS AND METHODS A total of 234 children born with clefts and 22 children born with primary VPI were evaluated. Children with associated abnormalities were excluded from this study. The Borel-Maisonny classification system was used to evaluate the velar insufficiency. The cranial-based pharyngeal flap was performed using the Sanvenero-Rosselli technique. RESULTS Between 1984 and 2001, 74 children underwent pharyngeal flap for VPI. The mean follow-up period was 7 years. Borel-Maisonny scores after pharyngeal flap surgery were as follows: children with UCLP (n = 22), 59.1% type 1, 36.4% type 1/2, and 4.5% type 2; children with BCLP (n = 18), 44.4% type 1, 27.8% type 1/2, 16.7% type 2, and 11.1% type 2/3; children with CP (n = 17), 64.7% type 1, 23.5% type 1/2, and 11.8% type 2; children with primary VPI (n = 17), 29.4% type 1, 29.4% type 1/2, 29.4% type 2/3, and 11.8% type 3. There were significant differences in outcome among the 4 groups (P = .029; Fisher exact test). CONCLUSIONS The positive effect on speech of a cranial-based pharyngeal flap is greater in children born with a UCLP or CP than in those born with a BCLP. In children born with primary VPI, this operation has only a slightly positive effect on speech that shows compensatory misarticulations; in such cases, alternative surgical choices or secondary procedures may be indicated. This information should be clearly conveyed to the parents in presurgical consultation so that they know what to expect from the procedure and postoperative adjuvant therapy.
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David DJ, Anderson PJ, Schnitt DE, Nugent MAC, Sells R. From Birth to Maturity: A Group of Patients Who Have Completed Their Protocol Management. Part II. Isolated Cleft Palate. Plast Reconstr Surg 2006; 117:515-26. [PMID: 16462334 DOI: 10.1097/01.prs.0000197135.95344.a0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal management of the cleft palate patient from birth to completion of treatment continues to present a formidable challenge to the plastic surgeon. The management by multidisciplinary teams is well established, but long-term outcome data of cases managed by protocol remain sparse. This study continues to present the results of the Australian Craniofacial Unit of patients with isolated cleft palate who completed protocol management at the unit under the care of the senior author (D.J.D.) during the 29-year period from 1974 to 2003. METHODS A retrospective study of the outcomes in relation to facial growth, speech, hearing, and occlusion is presented of patients with an isolated cleft palate. RESULTS Thirty-two cases were identified from the departmental database, involving 17 female patients and 15 male patients. Cephalometric analysis at skeletal maturity revealed a range of facial growth, and maxillary advancement surgery was deemed necessary in just two cases. Speech results were evaluated using speech therapy assessments during development and at maturity. At maturity, 18 of 32 patients were assessed as being within normal limits. The hearing was within -20 dB, with just two exceptions. CONCLUSION Overall, these is a range of outcomes, but the results confirm that facial growth does not appear to be adversely affected by use of the pushback technique to reconstruct the palate.
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Affiliation(s)
- David J David
- Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Persson C, Elander A, Lohmander-Agerskov A, Söderpalm E. Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations. Cleft Palate Craniofac J 2002; 39:397-408. [PMID: 12071788 DOI: 10.1597/1545-1569_2002_039_0397_soiicp_2.0.co_2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. DESIGN A cross-sectional retrospective study. SETTING A university hospital serving a population of 1.5 million inhabitants. SUBJECTS Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. INTERVENTIONS A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. MAIN OUTCOME MEASURES Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. RESULTS The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. CONCLUSION Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.
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Affiliation(s)
- Christina Persson
- Department of Logopedics and Phoniatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
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Persson C, Elander A, Lohmander-Agerskov A, Söderpalm E. Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations. Cleft Palate Craniofac J 2002. [DOI: 10.1597/1545-1569(2002)039<0397:soiicp>2.0.co;2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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