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An Observational Study to Evaluate Association Between Velopharyngeal Anatomy and Speech Outcomes in Adult Patients With Severe Velopharyngeal Insufficiency. J Craniofac Surg 2021; 32:2753-2757. [PMID: 34238870 DOI: 10.1097/scs.0000000000007853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE By measuring velopharyngeal structure and evaluating speech intelligibility, to explore and observe the association between velopharyngeal anatomy and speech outcomes in these patients. METHODS Thirty-one adult patients with velopharyngeal insufficiency after the primary palatoplasty aged 18 to 35 years (mean 22.03 years) were enrolled as the study group. The patients had significant hypernasality and audible nasal emission. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade III. Cephalometric analysis was performed on lateral cephalograms to measure velopharyngeal structure, including hard palate length (ANS-PNS), velar length (PNS-U), pharyngeal depth (PNS-PPW), and oropharyngeal airway space (U-MPW). Their speech intelligibility was evaluated through the Mandarin Chinese speech intelligibility test, and each speech sample was examined by 2 speech and language pathologists. The results were assessed with the SPSS 23.0 software package, and regression analysis was used to examine the relationship between velopharyngeal structure and speech outcomes. RESULTS A significant negative correlation was confirmed between speech intelligibility and pharyngeal depth. Pharyngeal depth also showed a linear relationship with speech intelligibility, and there was no significant correlation between speech intelligibility and other measures (hard palate length, velar length, oropharyngeal airway space). CONCLUSIONS In the velopharyngeal anatomy, only pharyngeal depth was associated with speech intelligibility in adult patients with severe velopharyngeal insufficiency, this is consistent with our clinical observation. It suggests that appropriate reduction of pharyngeal depth during palatopharyngoplasty may have a good effect on the speech recovery in patients with cleft palate and patients with velopharyngeal insufficiency after palatorrhaphy.
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Kato J, Mikoya T, Ito Y, Sato Y, Uematsu S, Kodama Y, Susami T, Yamanishi T, Takagi R. Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study. Cleft Palate Craniofac J 2021; 59:355-364. [PMID: 33910394 DOI: 10.1177/10556656211010606] [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 dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. DESIGN Retrospective, cross sectional. SETTING Three cleft palate centers (A, B, C) in Japan. PATIENTS Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. INTERVENTIONS In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. MAIN OUTCOME MEASURES Dental arch relationships were assessed using the 5-Year-Olds' (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. RESULTS Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B (P < .05). CONCLUSIONS There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.
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Affiliation(s)
- Junya Kato
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Mikoya
- Center for Advanced Oral Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yumi Ito
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshiaki Sato
- Department of Orthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Setsuko Uematsu
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takafumi Susami
- Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital, Tokyo, Japan
| | - Tadashi Yamanishi
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Ritsuo Takagi
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Otsuki K, Yamanishi T, Tome W, Shintaku Y, Seikai T, Fujimoto Y, Kogo M. Occlusion at 5 Years of Age Following Hard Palate Closure With Vestibular Flap. Cleft Palate Craniofac J 2019; 57:729-735. [PMID: 31847566 DOI: 10.1177/1055665619892474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to assess occlusal relationships and frequency of oronasal fistula at 5 years of age following 2 hard palate closure techniques and to compare results. DESIGN Retrospective longitudinal study. SETTING Institutional study. PATIENTS Study patients included 57 patients with nonsyndromic complete unilateral cleft lip and palate who were consecutively treated. All patients underwent our early 2-stage protocol for palatoplasty, which consisted of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age. Twenty-nine patients underwent hard palate closure using vestibular flap (VF group) technique (2009-2011) and 28 patients underwent conventional hard palate closure with local palatal flap (LPF group) technique (2006-2008). MAIN OUTCOME MEASURES Occlusal relationships were assessed with 5-year-olds' index, and frequency of oronasal fistula was investigated. RESULTS Average 5-year-olds' index scores for VF and LPF groups were 3.11 and 3.57, respectively (P < .001). Oronasal fistula occurred in approximately 7% of patients in the VF group and in 18% of patients in the LPF group. CONCLUSION Hard palate closure with VF technique may provide better occlusal relationships at 5 years of age than does conventional local closure with the LPF.
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Affiliation(s)
- Koichi Otsuki
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Tadashi Yamanishi
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Wakako Tome
- Department of Orthodontics, Oral Structure, Function, and Development, School of Dentistry, Asahi University, Gifu, Japan
| | - Yuko Shintaku
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Tetsuya Seikai
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Yukari Fujimoto
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Mikihiko Kogo
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
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Botticelli S, Küseler A, Mølsted K, Andersen HS, Boers M, Shoeps A, Emborg BK, Kisling-Møller M, Pedersen TK, Andersen M, Willadsen E. Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:420-429. [DOI: 10.1177/1055665619874143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.
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Affiliation(s)
- Susanna Botticelli
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | - Maria Boers
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | - Antje Shoeps
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | | | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Mikael Andersen
- Department of Plastic Surgery and Burns Treatment, University Hospital of Copenhagen, Denmark
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
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Abstract
Objective State-of-the-art activity demands a look back, a look around, and, importantly, a look into the new millennium. The area of speech and language has been an integral part of cleft palate care from the very beginning. This article reviews the development and progression of our knowledge base over the last several decades in the areas of speech; language; anatomy and physiology of the velopharynx; assessment of velopharyngeal function; and treatment, both behavioral and physical, for velopharyngeal problems. Method The clear focus is on the cleft palate condition. However, much of what is reviewed applies to persons with other craniofacial disorders and with other underlying causes of velopharyngeal impairment. A major challenge in the next several years is to sort through speech disorders that have a clear anatomic underpinning, and thus are more amenable to physical management, versus those that may be treated successfully using behavioral approaches. Speech professionals must do a better job of finding and applying ways of treating individuals with less severe velopharyngeal impairment, thus avoiding the need for physical management in these persons or ignoring the speech problem altogether. Conclusion Early and aggressive management for speech and language disorders should be conducted. For most individuals born with cleft conditions, a realistic goal should be normal speech and language usage by the time the child reaches the school-age years.
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Affiliation(s)
- David P. Kuehn
- University of Illinois at Urbana-Champaign, Champaign, Illinois
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Reiser E, Skoog V, Gerdin B, Andlin-Sobocki A. Association between cleft size and crossbite in children with cleft palate and unilateral cleft lip and palate. Cleft Palate Craniofac J 2014; 47:175-81. [PMID: 19860516 DOI: 10.1597/08-219_1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 06/07/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between cleft size in infancy and crossbite at 5 years of age in children with cleft palate (CP) and unilateral cleft lip and palate (UCLP). DESIGN Retrospective study. SETTING University Hospital, Uppsala, Sweden. PATIENTS Dental study models of 80 consecutive children, 51 children with CP and 29 children with UCLP, born between 1990 and 1999 were analyzed. INTERVENTIONS Lip repair at 3 to 4 months in UCLP children. Primary soft palate repair at 6 to 10 months and secondary hard palate closure at 25 to 26 months of age. MAIN OUTCOME MEASURES Maxillary arch dimensions and cleft size were measured on infancy dental casts. At follow-up at 5 years, crossbite scores were registered on dental study models. RESULTS The cleft dimensions in infancy showed large interindividual variation. Mean posterior cleft width was larger in UCLP children than in children with CP. The UCLP group also had significantly more crossbite at 5 years than the CP group. No significant association was noted between initial cleft size and crossbite scores at 5 years in the CP group. For the UCLP group, larger cleft widths at the level of the cuspid points were significantly associated with less anterior and posterior crossbite. CONCLUSIONS The findings support the hypothesis that cleft size in infancy affects early outcome with respect to crossbite in children with UCLP, but not in children with CP.
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Affiliation(s)
- Erika Reiser
- Department of Maxillofacial Surgery and Orthodontics, Uppsala University Hospital, Uppsala, Sweden.
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De Agostino Biella Passos V, De Carvalho Carrara CF, Da Silva Dalben G, Costa B, Gomide MR. Prevalence, Cause, and Location of Palatal Fistula in Operated Complete Unilateral Cleft Lip and Palate: Retrospective Study. Cleft Palate Craniofac J 2014; 51:158-64. [DOI: 10.1597/11-190] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors. Design Retrospective analysis of patient records and evaluation of preoperative initial photographs. Setting Tertiary craniofacial center. Participants Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007. Interventions The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate. Main outcome measures Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated. Results Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association ( P ≤ .05) between the fistulas and initial cleft width ( P = .0003), intraoperative problems ( P = .0037), and postoperative problems ( P = .00002). Conclusions The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.
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Affiliation(s)
| | | | | | - Beatriz Costa
- Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil
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Lohmander A, Friede H, Lilja J. Long-Term, Longitudinal Follow-Up of Individuals with Unilateral Cleft Lip and Palate after the Gothenburg Primary Early Veloplasty and Delayed Hard Palate Closure Protocol: Speech Outcome. Cleft Palate Craniofac J 2012; 49:657-71. [DOI: 10.1597/11-085] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate long-term, longitudinal speech outcome in patients born with unilateral cleft lip and palate treated according to a two-stage primary palatal protocol with early veloplasty and delayed hard palate closure. Design Retrospective, longitudinal cohort study. Setting A university hospital in western Sweden. Subjects A consecutive series of 55 patients from the total cohort of 65 were included. All patients had surgical procedures at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods Standardized audio recordings were blindly analyzed at 5, 7, 16, and 19 years of age and after at a clinical visit at 10 years of age. Typical cleft speech variables were rated independently on ordinal scales. Intelligibility and perceived velopharyngeal function were assessed also. Prevalences of speech characteristics were determined, and interrater and intrarater agreement were calculated. Results Prominent hypernasality, nasal air leakage, and retracted oral articulation at 5 years were markedly reduced throughout the years with low prevalences at ages 16 and 19 years. Perceived velopharyngeal competence was noted in 82% at age 16 and 87% at age 19 years along with normal intelligibility. Pharyngeal flap surgery was performed in 6 of the 55 patients (11%). Conclusions Long-term speech outcome in patients with two-stage palatoplasty with early soft palate repair was considered good and improved even before hard palate repair. The typical retracted oral articulation was quite frequent during the early ages; whereas, nonoral misarticulations were almost nonexistent, implying good velopharyngeal competence.
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Affiliation(s)
- Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technique, Karolinska Institute, and Speech-Language Pathologist at Karolinska University Hospital, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hans Friede
- Department of Orthodontics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Lilja
- Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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Juntaro N, Tadashi Y, Kohara H, Hirano Y, Sako M, Adachi T, Mukai T, Miya S. Early Two-Stage Palatoplasty Using Modified Furlow's Veloplasty. Cleft Palate Craniofac J 2010; 47:73-81. [DOI: 10.1597/08-067.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 06/28/2009] [Indexed: 11/22/2022] Open
Abstract
Objective To achieve sufficient velopharyngeal function and maxillary growth for patients with unilateral cleft lip and palate (UCLP), the authors have designed a new treatment protocol for palate closure involving early two-stage palatoplasty with modified Furlow veloplasty. Details of the surgical protocol and the outcomes of the dental occlusion of patients at 4 years of age are presented. Design and Setting This was an institutional retrospective study. Patients Seventy-two UCLP patients were divided into two groups based on their treatment protocols: patients treated using the early two-stage palatoplasty protocol (ETS group; n = 30) and patients treated using Wardill-Kilner push-back palatoplasty performed at 1 year of age (PB group; n = 42). Interventions The features of the ETS protocol are as follows: The soft palate is repaired at 12 months of age using a modified Furlow technique. The residual cleft in the hard palate is closed at 18 months of age. Lip repair is carried out at 3 months of age with a modified Millard technique for all subjects. Results The ETS group showed a significantly better occlusal condition than the PB group. The incidence of normal occlusion at the noncleft side central incisor was 7.1% in the PB group; whereas, it was 66.7% in the ETS group. Conclusion The results indicate that the early two-stage protocol is advantageous for UCLP children in attaining better dental occlusion at 4 years of age.
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Affiliation(s)
- Nishio Juntaro
- Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Yamanishi Tadashi
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Kohara
- Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Yoshiko Hirano
- Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Michiyo Sako
- Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Tadafumi Adachi
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Takao Mukai
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Shigenori Miya
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
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Image Analysis of Oronasal Fistulas in Cleft Palate Patients Acquired with an Intraoral Camera. Plast Reconstr Surg 2005. [DOI: 10.1097/01.prs.0000145634.14186.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Owman-Moll P, Katsaros C, Friede H. Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen. J Orofac Orthop 1998; 59:286-300. [PMID: 9800443 DOI: 10.1007/bf01321795] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n = 7 or unilateral [UCLP]; n = 22) or isolated cleft palate (CP; n = 9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate. The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.
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Affiliation(s)
- P Owman-Moll
- Department of Orthodontics, Göteborg University, Sweden.
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