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Al-Hassani M, Fowler P, Wren Y, Leary S, Davies A. Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes? Orthod Craniofac Res 2024; 27 Suppl 1:49-61. [PMID: 38193240 DOI: 10.1111/ocr.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. METHODS Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. RESULTS No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). CONCLUSION Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.
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Zanin EM, Arpini NE, Roth JC, Avalos GV, Duarte DW, Martins Collares MV. Dermal Matrix Graft Effects on Facial Growth in a Veau-Wardill-Kilner Palatoplasty Model: An Experimental Study in Rats. Cleft Palate Craniofac J 2024; 61:733-739. [PMID: 36373603 DOI: 10.1177/10556656221139674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty-due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation. The objective of this work was to test the use of an acellular dermal matrix (Mucograft®) in an experimental model of Veau-Wardill-Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa. Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau-Wardill-Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated. There were significant statistical differences between the groups for palate length growth (7.6 mm + -0.38 mm vs 5.5 mm + -0.36 mm, P = .009) and for palate width growth (1.47 mm + -0.8 mm vs -0.09 mm + -0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups. The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.
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Affiliation(s)
| | - Nícolas Endrigo Arpini
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Julia Caletti Roth
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Galo Verdugo Avalos
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daniele Walter Duarte
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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3
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Ghanem AM, Borg TM, Youssef G, Ridout D, Gilleard O, Birch M, Sell D, Sommerlad BC. Surgical Management of Submucous Cleft Palate by Radical Muscle Dissection Veloplasty: Speech Outcomes in Patients with 22q11.2 Deletion Syndrome. Cleft Palate Craniofac J 2024; 61:498-507. [PMID: 36624582 DOI: 10.1177/10556656221150707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the benefit of anatomical muscle dissection repair for velopharyngeal insufficiency (VPI) in patients with submucous cleft palate (SMCP) with 22q11.2 deletion syndrome. DESIGN Retrospective blinded randomised analysis of a surgeon's management over 10 years. SETTING The study was performed at a specialised Paediatric hospital in the United Kingdom. PATIENTS Children with SMCP and 22q11.2 deletion syndrome. INTERVENTIONS All participants underwent radical muscle dissection veloplasty. OUTCOMES MEASURED Pre- and post- operative measurements included severity of anatomical defect, speech samples and lateral images which were digitised, randomised then externally and blindly analysed using validated techniques. Stata software was used to perform statistical analysis. RESULTS 57 children with 22q11.2 deletion syndrome were included in this analysis. Intra-operatively, the majority of cases were identified as SMCP Grade I anomalies. Post-operatively, a statistically significant improvement in hypernasality, resting palate length, palate length at maximum closure, palate excursion and gap size at maximum closure was observed. Secondary surgery was performed for 59% of patients by ten years. CONCLUSION Muscle dissection repair improves hypernasality, palate closure function and the closure gap in patients with 22q11.2 deletion syndrome. Although over 50% of patients may require further surgery, muscle dissection repair should be a first step due to its utility at a younger age, when invasive investigations are impossible, its lower morbidity, speech and language benefits or altering the plans for less obstructive secondary surgery when it lead to reduced velo-pharyngeal gap and improved palate mobility even when adequate velo-pharyngeal closure was not achieved.
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Affiliation(s)
| | - Tiffanie-Marie Borg
- Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesborough, UK
- Academic Plastic Surgery Group, Barts and the London School of Medicine, London, UK
| | - Gehad Youssef
- Milner Therapeutics Institute, Cambridge University, Cambridge, UK
| | | | - Onur Gilleard
- Plastic and Reconstructive Surgery, Barts Health, London, UK
| | - Malcolm Birch
- Director of Clinical Physics, Barts Health, London, UK
| | - Debbie Sell
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
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4
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Schaar Johansson M, Becker M, Eriksson M, Stiernman M, Klintö K. Surgical treatment of velopharyngeal dysfunction: Incidence and associated factors in the Swedish cleft palate population. J Plast Reconstr Aesthet Surg 2024; 90:240-248. [PMID: 38387421 DOI: 10.1016/j.bjps.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/30/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Speech in children with cleft palate can be affected by velopharyngeal dysfunction, which persists after primary palate repair. The incidence of surgery to correct velopharyngeal dysfunction in this patient group has previously been reported as 2.6-37%. We aimed to investigate the incidence of velopharyngeal dysfunction surgery in Swedish children with cleft palate and to examine potential associations of independent variables with this incidence. METHODS In this cohort study, we analysed data from the Swedish cleft lip and palate quality registry for 1093 children with cleft palate with or without cleft lip. Kaplan-Meier analysis was used to estimate the risk of having velopharyngeal dysfunction surgery. Multivariable Cox proportional hazards models were used to estimate the associated effect of cleft subtype, additional diagnoses, gender, and age at and number of stages for primary palate repair on the primary outcome. RESULTS The risk of having velopharyngeal dysfunction surgery was 25.6%. Complete primary palate repair after the age of 18 months or in more than one stage was associated with a higher risk, but it could not be determined which of these was the more significant factor. Cleft soft palate was associated with a significantly lower risk than other cleft subtypes. CONCLUSIONS Primary palate repair at a higher age or in more than one stage may increase the risk of having velopharyngeal dysfunction surgery. Further analysis of potential unknown confounding factors and the association between the incidence of velopharyngeal dysfunction and surgery to correct this condition is needed.
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Affiliation(s)
- Malin Schaar Johansson
- Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Sweden; Division of Speech Language Pathology, Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden.
| | - Magnus Becker
- Division of Surgery, Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marie Eriksson
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Mia Stiernman
- Division of Surgery, Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Kristina Klintö
- Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Sweden; Division of Speech Language Pathology, Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
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Denadai R, Seo HJ, Go Pascasio DC, Sato N, Murali S, Lo CC, Chou PY, Lo LJ. Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible? Cleft Palate Craniofac J 2024; 61:247-257. [PMID: 36066016 DOI: 10.1177/10556656221123917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. DESIGN Retrospective single-surgeon study. PATIENTS Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. INTERVENTIONS Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). MEAN OUTCOME MEASURES Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. RESULTS Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). CONCLUSION This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dax Carlo Go Pascasio
- Section of Plastic and Reconstructive Surgery, Southern Philippines Medical Center, Davao, Philippines
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Srinisha Murali
- Oral and Maxillofacial Surgery, Kumaran Clinic and Nursing Home Trichy, Tamil Nadu, India
| | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Koh KS, Jung S, Park BR, Oh TS, Kim YC, Ha S. Speech Outcomes in 5-Year-Old Korean Children with Bilateral Cleft Lip and Palate. Arch Plast Surg 2024; 51:80-86. [PMID: 38425862 PMCID: PMC10901596 DOI: 10.1055/a-2175-1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background Among the cleft types, bilateral cleft lip and palate (BCLP) generally requires multiple surgical procedures and extended speech therapy to achieve normal speech development. This study aimed to describe speech outcomes in 5-year-old Korean children with BCLP and examine whether normal speech could be achieved before starting school. Methods The retrospective study analyzed 52 children with complete BCLP who underwent primary palatal surgery at a tertiary medical center. Three speech-language pathologists made perceptual judgments on recordings from a speech follow-up assessment of 5-year-old children. They assessed the children's speech in terms of articulation, speech intelligibility, resonance, and voice using the Cleft Audit Protocol for Speech-Augmented-Korean Modification. Results The results indicated that at the age of five, 65 to 70% of children with BCLP presented articulation and resonance within normal or acceptable ranges. Further, seven children with BCLP (13.5%) needed both additional speech therapy and palatal surgery for persistent velopharyngeal insufficiency and speech problems even at the age of five. Conclusion This study confirmed that routine follow-up speech assessments are essential as a substantial number of children with BCLP require secondary surgical procedures and extended speech therapy to achieve normal speech development.
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Affiliation(s)
- Kyung S. Koh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungeun Jung
- Division of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, Hallym University, Chuncheon, Korea
| | - Bo Ra Park
- Department of Rehabilitation Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Suk Oh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seunghee Ha
- Division of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, Hallym University, Chuncheon, Korea
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Hofman L, van Dongen JA, van Rees RCM, Jenniskens K, Haverkamp SJ, Beentjes YS, van der Molen ABM, Paes EC. Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis. Clin Oral Investig 2023; 28:58. [PMID: 38157017 DOI: 10.1007/s00784-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome. MATERIALS AND METHODS A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model. RESULTS One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15-24), after Z-palatoplasty 6% (95% CI 4-9), and after palatoplasty with buccal flaps 7% (95% CI 4-11). CONCLUSIONS A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair. CLINICAL RELEVANCE Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality.
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Affiliation(s)
- Lieke Hofman
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Joris A van Dongen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Kevin Jenniskens
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sarah J Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Yente S Beentjes
- Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Gamble C, Munro K. Timing of Primary Surgery for Cleft Palate. Reply. N Engl J Med 2023; 389:2209. [PMID: 38063334 DOI: 10.1056/nejmc2311517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Kevin Munro
- University of Manchester, Manchester, United Kingdom
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9
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Butterworth S, Fitzsimons KJ, Medina J, Britton L, Van Eeden S, Wahedally H, Park MH, van Der Muelen J, Russell CJH. Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate. Cleft Palate Craniofac J 2023; 60:1578-1590. [PMID: 35733360 DOI: 10.1177/10556656221110094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ± lip (CP ± L). 3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland. Perceptual speech analysis utilized the Cleft Audit Protocol for Speech-Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)-speech within the normal range, SS2a-no structurally related speech difficulties or history of speech surgery, and SS3-speech without significant cleft-related articulation difficulties. Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP-aOR 0.719 [CI 0.591-0.875]; BCLP-aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete-aOR 0.701 [CI 0.540-0.909]; complete-aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent. Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.
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Affiliation(s)
- Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Kate J Fitzsimons
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Jibby Medina
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Lorraine Britton
- Trent Regional Cleft Network, Nottingham University Hospital NHS Trust, Nottingham, UK
| | | | | | - Min Hae Park
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan van Der Muelen
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Craig J H Russell
- Royal Hospital for Children, Queen Elisabeth University Hospital, Glasgow, UK
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10
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Haenssler AE, Mann R, Gilbert IR, Snodgrass T, Mann S, Kampfshulte A, Perry JL. Anatomical and Physiological Changes Following Primary Palatoplasty Using "The Buccal Flap Approach". Cleft Palate Craniofac J 2023:10556656231215141. [PMID: 38037274 DOI: 10.1177/10556656231215141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the anatomical differences among selected individuals with a cleft palate repaired using "The Buccal Flap Approach" during primary palatoplasty compared to aged-matched participants without cleft palate. DESIGN Observational, prospective. SETTING Two regional hospitals. PARTICIPANTS A total of 30 adult males consisting of 15 adults born with cleft palate who received the Double Opposing Z-Plasty plus Buccal Flaps (DOZP + BF) repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery and 15 adults without a history of cleft palate. INTERVENTIONS All participants underwent MRI to visualize anatomy. MAIN OUTCOME MEASURES Ten velopharyngeal and craniofacial anatomical measures. RESULTS No statistically significant differences between groups were observed for velar thickness, velar length, pharyngeal depth, NSBa angle, SNB angle, or levator veli palatini length. Individuals with the DOZP + BF presented with a greater effective velar length (p < .001), greater effective VP ratio (p < .001), smaller SNA angle (p < .001), and smaller maximal velar stretch (p < .001) compared to the control participants. CONCLUSIONS This study suggests that adult males who received the DOZP + BF repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery present with a longer effective velar length and larger effective VP ratio in comparison to the non-cleft group. Future research is needed to compare patients with and without favorable outcomes from multiple surgical types to fully understand how surgical techniques alter the anatomy.
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Affiliation(s)
- Abigail E Haenssler
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Robert Mann
- Healing the Children, Michigan/Ohio Chapter, Grand Rapids, MI, USA
| | - Imani R Gilbert
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Taylor Snodgrass
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | | | - Andy Kampfshulte
- Spectrum Health Offices of Research, Spectrum Health, Grand Rapids, MI, USA
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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11
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Dunworth K, Sharif-Askary B, Grames L, Jones C, Kern J, Nyswonger-Sugg J, Suárez A, Thompson K, Ching J, Golden B, Merrill C, Nguyen P, Patel K, Rogers-Vizena CR, Rottgers SA, Skolnick GB, Allori AC. Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network. Cleft Palate Craniofac J 2023:10556656231207469. [PMID: 37844605 DOI: 10.1177/10556656231207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. DESIGN Cross-sectional analysis of prospectively collected data from 2019-2022. SETTING Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. PARTICIPANTS 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. INTERVENTION Routine multidisciplinary care and systematic outcomes measurement by cleft teams. OUTCOME MEASURES Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. RESULTS 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. CONCLUSIONS This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.
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Affiliation(s)
- Kristina Dunworth
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Banafsheh Sharif-Askary
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Jennifer Kern
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Jillian Nyswonger-Sugg
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Arthur Suárez
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Karen Thompson
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Ching
- University of Florida Craniofacial Center, University of Florida, Gainesville, FL, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Brent Golden
- Pediatric Cleft Lip and Palate Surgery Program, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Phuong Nguyen
- Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamlesh Patel
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Carolyn R Rogers-Vizena
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - S Alex Rottgers
- Cleft and Craniofacial Center, Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alexander C Allori
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
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12
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Gustafsson C, Heliövaara A, Rautio J, Leikola J. Long-term Follow-up of Bilateral Cleft Lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation. Cleft Palate Craniofac J 2023; 60:1241-1249. [PMID: 35726173 PMCID: PMC10515470 DOI: 10.1177/10556656221102816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While bilateral cleft lip and palate (BCLP) constitutes a clinical challenge for the whole cleft team, the ideal surgical protocol remains obscure. This study presents the long-term burden of care in terms of secondary surgeries, defined as fistula repair and speech-correcting surgeries (SCS), in a single center. Outcomes of two surgical protocols utilized over the years were also compared. A retrospective single-center analysis of 81 non-syndromic children with complete BCLP born between 1990 and 2010. Two surgical protocols comprising single-stage and two-stage (delayed hard palate closure) procedures were compared. Outcome was analyzed at the time of alveolar bone grafting (ABG) and post-ABG. Altogether 54 children (66.7%) had underwent secondary surgery by the time of bilateral ABG. At this point, 38.3% (n = 31) of patients had received SCS and 49.4% (n = 40) had undergone fistula repair. The corresponding incidences at the end of follow-up were 46.9% (n = 38) and 53.1% (n = 43). No significant difference emerged in SCS incidence between the 2 protocols; however, prior to ABG the single-stage protocol had a significantly lower need for fistula repair. Regarding the location of fistulas, some differences were observed, with the single-stage procedure more associated with anterior fistulas. BCLP has a high surgical burden of care in terms of secondary surgeries, defined as SCS and fistula repair. In our experience, the single-stage protocol, particularly the two-flap technique, offers better results in the management of BCLP than the two-stage approach with a short delay in hard palate closure.
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Affiliation(s)
| | - Arja Heliövaara
- Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Jorma Rautio
- Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
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13
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Pereira VJ, Sell D. How differences in anatomy and physiology and other aetiology affect the way we label and describe speech in individuals with cleft lip and palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 37650488 DOI: 10.1111/1460-6984.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Speech in individuals with cleft lip and/or palate (CLP) is a complex myriad of presenting symptoms. It is uniquely associated with the structural difference of velopharyngeal insufficiency (VPI), together with a wide and heterogeneous range of other aetiologies which often co-occur. The nature of the speech sound disorder (SSD) including VPI may also change over the course of an individual's care pathway. Differences in terminology and approaches to analysis are currently used, resulting in confusion internationally. Additionally, current diagnostic labels and classification systems in SSD do not capture the complexity and full nature of speech characteristics in CLP. AIMS This paper aims to explore the different aetiologies of cleft palate/VPI speech and to relate aetiology with speech characteristic(s). In so doing, it attempts to unravel the different terminology used in the field, describing commonalities and differences, and identifying overlaps with the speech summary patterns used in the United Kingdom and elsewhere. The paper also aims to explore the applicability of current diagnostic labels and classification systems in the non-cleft SSD literature and illustrate certain implications for speech intervention in CLP. METHODS AND PROCEDURES The different aetiologies were identified from the literature and mapped onto cleft palate/VPI speech characteristics. Different terminology and approaches to analysis are defined and overlaps described. The applicability of current classification systems in SSD is discussed including additional diagnostic labels proposed in the field. OUTCOMES AND RESULTS Aetiologies of cleft palate/VPI speech identified include developmental (cognitive-linguistic), middle ear disease and fluctuating hearing loss, altered oral structure, abnormal facial growth, VPI-structural (abnormal palate muscle) and VPI-iatrogenic (maxillary advancement surgery). There are four main terminologies used to describe cleft palate/VPI speech: active/passive and compensatory/obligatory, which overlap with the four categories used in the UK speech summary patterns: anterior oral cleft speech characteristics (CSCs), posterior oral CSCs, non-oral CSCs and passive CSCs, although not directly comparable. Current classification systems in non-cleft SSD do not sufficiently capture the full nature and complexity of cleft palate/VPI speech. CONCLUSIONS AND IMPLICATIONS Our attempt at identifying the heterogeneous range of aetiologies provides clinicians with a better understanding of cleft palate/VPI speech to inform the management pathway and the nature and type of speech intervention required. We hope that the unravelling of the different terminology in relation to the UK speech summary patterns, and those used elsewhere, reduces confusion and provides more clarity for clinicians in the field. Diagnostic labels and classification require international agreement. WHAT THIS PAPER ADDS What is already known on the subject Speech associated with cleft palate/velopharyngeal insufficiency (VPI) is a complex myriad of speech characteristics with a wide and heterogeneous range of aetiologies. Different terminology and speech summary patterns are used to describe the speech characteristics. The traditional classification of cleft palate/VPI speech is Articulation Disorder, although evidence is building for Phonological Disorder and contrastive approaches in cleft speech intervention. What this paper adds to existing knowledge This paper explores the range of aetiologies of cleft palate/VPI speech (e.g., altered oral structure, abnormal facial growth, abnormal palate muscle and iatrogenic aetiologies) and attempts to relate aetiology with speech characteristic(s). An attempt is made at unravelling the different terminology used in relation to a well-known and validated approach to analysis, used in the United Kingdom and elsewhere. Complexities of current diagnostic labels and classifications in Speech Sound Disorder to describe cleft palate/VPI speech are discussed. What are the potential or actual clinical implications of this work? There needs to be a common language for describing and summarising cleft palate/VPI speech. Speech summary patterns based on narrow phonetic transcription and correct identification of aetiology are essential for the accurate classification of the speech disorder and identification of speech intervention approaches. There is an urgent need for research to identify the most appropriate type of contrastive (phonological) approach in cleft lip and/or palate.
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Affiliation(s)
- Valerie J Pereira
- Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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Huang H, Li J, Li C, Yin H, Wu M, Wang Y, Li Y, Yang C, Zeng N, Zheng Q, Shi B. Sommerlad-Furlow modified palatoplasty: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00058-6. [PMID: 37164835 DOI: 10.1016/j.jcms.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/27/2023] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
The purpose of this study was to introduce the surgical process of Sommerlad-Furlow modified (S-F) palatoplasty and compare its surgical and functional outcomes with conventional Sommerlad (S) palatoplasty. Patients with non-syndromic cleft palate who had undergone either S-F palatoplasty or S palatoplasty were retrospectively reviewed. Data on the outcomes of velopharyngeal function and postsurgical palatal fistula incidence were collected for all patients. Data for preselected factors, including gender, age at palatoplasty, and cleft type, were also collected. Chi-square tests were conducted. 1254 patients were included. The postsurgical velopharyngeal competence (VPC) rate after S-F palatoplasty was significantly higher than after S palatoplasty (total, 70.5% vs 57.9%, p < 0.0001; age ≤ 1, 87.0% vs 69.2%, p < 0.0001; 1 < age ≤ 2, 78.3% vs 69.3%, p = 0.0479). With regard to different types of cleft palate, the postsurgical VPC rates after S-F palatoplasty were all significantly higher than for S palatoplasty in all patients younger than 2 years of age (complete cleft palate, 78.7% vs 62.4%, p = 0.0016; hard and soft palate cleft, 84.4% vs 74.8%, p = 0.0172; submucosal cleft and soft palate cleft, 96.6% vs 68.4%, p = 0.0114). The postoperative fistula rate after S-F palatoplasty was 4.3%. This modified palatoplasty technique provided adequate cleft palate closure, with satisfactory speech outcomes and low fistula rates, while older age at palatoplasty may affect the postsurgical outcomes. Within the limitations of the study it seems that the Sommerlad-Furlow modified technique is an option for cleft palate repair.
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Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chenghao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Heng Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Min Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yang Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
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15
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Speech Symptoms of Velopharyngeal Insufficiency and the Incidence of Secondary Speech Surgery in 10-Year-Old Children With Unilateral Cleft Lip and Palate: Comparison of 2 Randomized Surgical Methods for Primary Palatal Surgery. J Craniofac Surg 2023; 34:461-466. [PMID: 36000743 DOI: 10.1097/scs.0000000000008926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare speech symptoms of velopharyngeal insufficiency (VPI) and incidence of secondary speech surgery in 10-year-old Finnish children with unilateral cleft lip and palate (UCLP) following primary palatal surgery using 2 surgical methods. DESIGN Single center analysis within the Scandcleft multicenter randomized controlled trial of primary surgery for UCLP. MATERIALS AND METHODS Patients comprised 79 nonsyndromic 10-year-old children with UCLP. Two randomized surgical methods were used in the primary palatal surgery: soft palate closure at 4 months and hard palate closure at 12 months (Arm A) and closure of both the soft and hard palate at 12 months (Arm C). Speech symptoms of VPI were analyzed from standardized video recordings by 2 experienced speech pathologists. The incidences of surgery for correcting VPI, fistula closure, and speech therapy were evaluated retrospectively from patient records. RESULTS No differences in speech symptoms of VPI, need for VPI surgery or speech therapy were found between the surgical methods. Of all 79 children, 33% had had VPI surgery and 61% had speech therapy. The number of fistulas was significantly higher in Arm A (25%) than in Arm C (2%). Moderate to severe speech symptoms of VPI (hypernasality, continuous nasal air leakage, weak pressure consonants, and/or compensatory articulation) were found in 11% of the children. CONCLUSION No differences were present between groups in speech symptoms of VPI or need for VPI surgery or speech therapy between the 2 surgical methods. One third of the children had undergone VPI surgery. Most of the children (89%) had good or relatively good speech.
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Bschorer F, Hornig L, Schön G, Bschorer R. Speech assessment following microsurgical soft palate repair. J Craniomaxillofac Surg 2023; 51:199-204. [PMID: 36878754 DOI: 10.1016/j.jcms.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 11/01/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to analyze speech intelligibility of children, who had undergone microsurgical soft palate repair according to Sommerlad. Cleft palate patients were treated by closure of the soft palate according to Sommerlad at about 6 months of age. At the age of 11, their speech was evaluated through automatic speech recognition. Word recognition rate (WR) was used as the outcome parameter of automatic speech recognition. To validate automatic speech results, an institute for speech therapy evaluated the speech samples for perceptual intelligibility. The results of this study group were compared to an age-matched control group. A total of 61 children were evaluated in this study, 29 in the study group and 32 in the control group. Study group patients had a lower word recognition rate (mean 43.03, SD 12.31) compared to the control group (mean 49.98, SD 12.54, p = 0.033). The magnitude of the difference was considered small (95% CI of the difference 0.6-13.3). The study group patients received significantly lower scores in the perceptual evaluation (mean 1.82, SD 0.58) compared to the control group mean (mean 1.51, SD 0.48, p = 0.028). Again, the magnitude of the difference was small (95% CI of the difference 0.03-0.57). Within the limitations of the study it seems that microsurgical soft palate repair according to Sommerlad at the age of 6 months might be a relevant alternative to other well established surgical techniques.
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Affiliation(s)
- Frizzi Bschorer
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany; Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany.
| | - Lena Hornig
- ISBA University of Cooperative Education, Ziegelseestr. 1, 19055, Schwerin, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, Eppendorf University Hospital, University of Hamburg, Martinistr. 52, D-20246, Hamburg, Germany
| | - Reinhard Bschorer
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany; MKG-Praxis Am Stadthafen, Schliemannstraße 18, 19055, Schwerin, Germany
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17
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Pollet N, Mennes T, Denys S, Loos E, Verhaert N, Vander Poorten V, Hens G. Otomicroscopic and functional outcomes after cleft palate repair via Sommerlad intravelar veloplasty vs. modified Veau-Wardill-Kilner push-back. Int J Pediatr Otorhinolaryngol 2022; 162:111283. [PMID: 35998528 DOI: 10.1016/j.ijporl.2022.111283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aim to compare the modified Veau-Wardill-Kilner push-back technique (VWK) and the Sommerlad intravelar veloplasty (Sommerlad IVVP) in terms of middle ear outcomes and oronasal fistulae frequency in three years old children. METHODS For this retrospective cohort study, data were collected and anonymized from consecutive patients with cleft palate (with or without cleft lip) who underwent surgery in our hospital between January 2008 and December 2018. Patients with syndromic diagnoses and patients who underwent surgical treatment elsewhere were excluded. We collected data from 101 children (202 ears) regarding middle ear complications at the age of three, including acute otitis media, middle ear effusion, tympanic membrane retraction, tympanic membrane perforation, tympanic membrane atelectasis and chronic otitis media with cholesteatoma. In addition, the presence of oronasal fistulae and the number of ventilation tubes received by the age of three were recorded. RESULTS The odds of children having a normal middle ear evaluation were 3.07 (95% Confidence interval (95%CI): [1.52, 6.12]; p < 0.05) times higher when children received Sommerlad IVVP compared to modified VWK. With 40.7% compared to 26.7%, a significantly higher incidence of middle ear effusion was present in the modified VWK group compared to Sommerlad IVVP (X2(1) = 4.38, p < 0.05). Furthermore, this group needed significantly more ventilation tube reinsertions (X2(2) = 12.22, p < 0.05) and was found to have a significantly higher incidence of oronasal fistula (53.5% vs. 17.2%, X2(1) = 14.75, p < 0.05). The latter was significantly associated with a higher need for ventilation tube reinsertion (X2(1) = 7.34, p < 0.05). CONCLUSION This study shows superior middle ear outcomes and fewer oronasal fistulae after Sommerlad IVVP compared to modified Veau-Wardill-Kilner push-back at the age of three.
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Affiliation(s)
- Naomi Pollet
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Tillo Mennes
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Sam Denys
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Elke Loos
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Nicolas Verhaert
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Oncology, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Greet Hens
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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18
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Nachmani A, Biadsee A, Masalha M, Kassem F. Compensatory Articulation Errors in Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2518-2539. [PMID: 35858260 DOI: 10.1044/2022_jslhr-21-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to assess the frequency and types of compensatory articulations (CAs) in nonsyndromic patients with velopharyngeal dysfunction (VPD) and various palatal anomalies and to determine the relationship between the frequency of CAs, type of palatal anomaly, and phonological errors. METHOD A total of 783 nonsyndromic, Hebrew-speaking patients with VPD and various palatal anomalies (cleft lip and palate [CLP], cleft palate [CP], submucous CP [SMCP], occult submucous CP [OSMCP], or non-CP) were studied retrospectively. Perceptual VPD tests, including articulation and phonological assessment, were conducted. CAs were described as below the level of the defect in the vocal tract (abnormal backing of oral targets to post-uvular place) or in front of it within the oral cavity (palatalization) and at the velopharyngeal port. RESULTS Among 783 patients, 213 (27.2%) had CAs. Most CAs (18.4%) occurred below the level of the defect, followed by CAs at the velopharyngeal port (12.0%) or in front of it (4.9%). No differences were found in the frequency of CAs between patients with CP (47.8%) or CLP (52.6%) and between those with non-CP (13.6%) or OSMCP (14.7%). SMCP patients had lower frequency of CAs (29.8%) than CP (p = .003) and CLP (p = .002) patients but higher frequency than OSMCP (p = .002) and non-CP (p = .002) patients did. Among the 783 patients, 247 (31.5%) had phonological errors. A higher frequency of phonological errors was found in patients with CAs (55.4%) compared to those without (22.6%) and in all palatal anomaly groups except CLP (31.4% vs. 23.9%). CONCLUSIONS CAs in nonsyndromic patients with VPD remained relatively high in all age groups, up to adulthood. CAs are influenced by inadequate velar length following palatal repair, as well as by oral structural abnormalities, whereas poor muscle function due to OSMCP and/or abnormal size and/or shape of nasopharynx has less influence. Errors produced in front of the velopharyngeal port are influenced by the structural anomaly of CLP. This information may contribute to general phonetic and phonological theories and genetic investigations about CP anomalies.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
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19
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Morrison MM, Mason NT, Forde BL, Stone PR, Fowler PV, Thompson JMD. Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age. Cleft Palate Craniofac J 2021; 59:1400-1412. [PMID: 34672811 DOI: 10.1177/10556656211044939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN Prospective study. PARTICIPANTS Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.
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Affiliation(s)
- Maeve M Morrison
- Department of Allied Health, 1400Middlemore Hospital, Counties Manukau District Health Board.,Department of Plastics, 1400Middlemore Hospital, Counties Manukau District Health Board
| | - Nicola T Mason
- Speech Language Therapy, 67587Christchurch Hospital, Canterbury District Health Board
| | - Bryony L Forde
- Speech Language Therapy, 161292Hutt Valley Hospital, Hutt Valley District Health Board
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand
| | | | - John M D Thompson
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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20
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Hardin-Jones MA, Chapman KL. Non-Oral Compensatory Misarticulations Revisited. Cleft Palate Craniofac J 2021; 59:976-983. [PMID: 34184568 DOI: 10.1177/10556656211026488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-oral compensatory misarticulation patterns are often associated with the speech of children with cleft palate. Despite their saliency, the etiology, frequency, and treatment of these misarticulations have not been studied extensively. The purpose of this commentary is to review what we know about these atypical patterns of articulation and address clinical assumptions regarding their etiology and treatment.
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Fell M, Medina J, Fitzsimons K, Seifert M, Roberts A, Russell C, Deacon S. The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age. Cleft Palate Craniofac J 2021; 59:453-461. [PMID: 33887986 DOI: 10.1177/10556656211010620] [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 This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. PARTICIPANTS In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. OUTCOME MEASURES Maxillary growth was analyzed using dental models scored by the 5-Year-Olds' index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech - Augmented rating. RESULTS Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old' index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth (P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. CONCLUSION The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.
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Affiliation(s)
- Matthew Fell
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Kate Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Miriam Seifert
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Anne Roberts
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Craig Russell
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Scott Deacon
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Butterworth S, Hodgkinson EL, Sainsbury DCG, Hodgkinson PD. Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty. Cleft Palate Craniofac J 2021; 58:1490-1499. [PMID: 33517708 DOI: 10.1177/1055665621989139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. OBJECTIVE To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). DESIGN An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. METHOD A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. RESULTS Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme-Surgical Variation-is discussed. CONCLUSIONS The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.
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Affiliation(s)
- Sophie Butterworth
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Emma L Hodgkinson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David C G Sainsbury
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter D Hodgkinson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Peryer H, Slator R, Thomson J, Richard B. The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:419-428. [PMID: 32959681 DOI: 10.1177/1055665620956872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE It was hypothesized that lip repair protocols in children with bilateral cleft lip and palate (BCLP) would affect development of bilabial consonants /m/ /b/ /p/. This study compared speech outcomes in 2 surgical groups. DESIGN A retrospective case note investigation. SETTING UK Cleft Centre (2000-2009). PATIENTS Forty-nine children with complete BCLP, of whom 26 had a 1-stage and 23 a 2-stage bilateral cleft lip repair. INTERVENTIONS One-stage cleft lip repair versus a 2-staged cleft lip repair. MAIN OUTCOME MEASURES Bilabial consonant production at 18 months, 3 and 5 years of age. Cleft Speech Characteristics (CSCs) at age 5. RESULTS At age 18 months, 81% of the 1-stage lip repair group and 4% of the 2-stage lip repair group produced bilabial consonants (P <·0001, Fisher test). At age 3 years, 81% of the 1-stage and 26% of the 2-stage lip repair groups produced bilabial consonants (P =·0133, Fisher test). At age 5 years, both groups had similar bilabial consonant production, but children in the 2-stage lip repair group had more frequent and severe CSCs (P = ·0037, χ2). CONCLUSION A 1-stage lip repair for children with complete BCLP resulted in better bilabial consonant production at 18 months and 3 years of age than a 2-stage lip repair. At age 5 years both groups had bilabial consonants but children in the 2-stage lip repair group had worse CSCs. The surgical protocol for bilateral cleft lip repair affected speech outcome in children with BCLP.
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Affiliation(s)
- Holly Peryer
- West Midlands Cleft Lip and Palate Centre, 156630Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Rona Slator
- West Midlands Cleft Lip and Palate Centre, 156630Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Jenny Thomson
- Department of Human Communication Sciences, 7315The University of Sheffield, Mushroom Lane, Sheffield, United Kingdom
| | - Bruce Richard
- West Midlands Cleft Lip and Palate Centre, 156630Birmingham Children's Hospital, Birmingham, United Kingdom
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