Speech Results after One-Stage Palatoplasty with or without Muscle Reconstruction for Isolated Cleft Palate

• Published in: The Cleft palate-craniofacial journal Vol. 47; no. 1; pp. 92 - 103
• Main Authors: Nyberg, Jill, Westberg, Liisi Raud, Neovius, Erik, Larson, Ola, Henningsson, Gunilla
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2010; American Cleft Palate-Craniofacial Association; SAGE PUBLICATIONS, INC
• Subjects: Articulation Disorders - etiology; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; Cleft Palate - complications; Cleft Palate - surgery; Cross-Sectional Studies; Deformities; Dentistry; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Humans; Male; Maxillofacial surgery; Medical sciences; Medicin och hälsovetenskap; Mouth; Non tumoral diseases; Oral Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Palatal Muscles - surgery; Palate, Hard - surgery; Palate, Soft - surgery; Reconstructive Surgical Procedures - methods; Retrospective Studies; Studies; Surgical Flaps; Velopharyngeal Insufficiency - complications; Velopharyngeal Insufficiency - etiology; Voice Disorders - etiology; speech assessment; surgical technique; velopharyngeal incompetence; velopharyngeal flap; isolated cleft palate; articulation; velopharyngeal ncompetence; Palatine velum; Cleft palate; Speech articulation; Stomatology; Congenital cleft; Anatomical reconstruction; Congenital disease; Pharynx; Plasty; Treatment; Malformation; Surgery; Oral cavity disease; Muscle; Technique; Flap (surgery)
• DOI: 10.1597/08-222.1
• ISSN: 1055-6656; 1545-1569

Objective To investigate speech outcome between children with isolated cleft palate undergoing palatoplasty with and without muscle reconstruction and to compare speech outcomes between cleft and noncleft children. The number of subsequent velopharyngeal flaps was compared with respect to surgical techniques and cleft extent. Design Cross-sectional retrospective study. Participants One hundred four children aged 4 years, 0 months to 6 years, 0 months, 33 with isolated cleft of the soft palate, 53 with isolated cleft of the hard and soft palate, and 18 noncleft children. Interventions Two primary palate repair techniques: minimal incision technique (MIT) and minimal incision technique including muscle reconstruction (MITmr). Main Outcome Measures Perceptual judgment of seven speech parameters assessed on a five-point scale. Results No significant differences in speech outcomes were found between MIT and MITmr surgery groups. The number of velopharyngeal flaps was significantly lower after MITmr surgery compared to MIT surgery. The number of flaps was also significantly lower in children with cleft of the soft palate compared to children with cleft of the hard and soft palate. Children with cleft of the soft palate had significantly less glottal articulation and weak pressure consonants compared to children with cleft of the hard and soft palate. Conclusions The MITmr surgery technique was not significantly superior to the MIT technique regarding speech outcomes related to velopharyngeal competence, but had fewer velopharyngeal flaps, which is contradictory. Until a larger sample can be studied, we will continue to use MITmr for primary palate repair.