Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

Abstract

Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.

Non-Oral Compensatory Misarticulations Revisited

“…A comparable (or lower) percentage of children with non-oral CMAs have been reported in other countries/languages as well in recent years (Ainoda et al, 1985; Park et al, 2000; Persson et al, 2006; Albustanji et al, 2014: Baillie & Sell, 2020; Hortis-Dzierzbicka et al, 2014; Klinto et al, 2014; Sell et al, 2015; Willadsen et al, 2017; Nyberg et al, 2018). Sell and colleagues (2015) reported speech outcomes for 248 five-year-old children in the Cleft Care UK study and noted that only 10% produced non-oral CMAs.…”

“…Although a high percentage of substitutions seen in these children were attributed to glottal stops and pharyngeal fricatives in the early 1960s (Spriestersbach et al, 1961; Westlake & Rutherford, 1966), several authors were reporting a decrease in the frequency of these atypical substitutions even at that time (Morley, 1962; Renfrew, 1968). The number of children who produce CMAs has declined over the years and that observation has been attributed, at least in part, to the earlier age that palatal surgery is being performed as well as early intervention (Ysunza et al, 1998; Hardin-Jones & Jones, 2005; Peterson-Falzone et al, 2010; Baillie & Sell, 2020).…”

The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate

“…It is likely that speech-language therapy intervention was similar across both groups but we do not know if there were differences in the speech-language therapy intervention they received. Information on the quantity and quality of speech-language therapy intervention has been noted to be difficult to obtain in other studies (Baillie and Sell, 2020). Lack of this information means it is not possible to know how speech-language therapy intervention may have had an impact on the results at any of the assessment time points.…”

“…Bilateral cleft lip and palate (BCLP) is rare, making up approximately 10% of the overall cleft population (Cleft Registry and Audit Network, 2019), and in many studies that have reported speech development and speech outcomes in children with cleft palate, children with BCLP were excluded (Lohmander, 2011). Where children with BCLP have been included in such studies (Hardin-Jones and Jones, 2005; Sullivan et al, 2009; Mahoney et al, 2013; Choa et al, 2014; Klintö et al, 2018; Baillie and Sell, 2020) they have consistently presented with less favorable speech outcomes and more surgical complications. According to the Cleft Registry and Audit Network (2019), only 36.2% of children with BCLP were rated to have “normal speech” at age 5 years (Cleft Registry and Audit Network, 2019), compared to 73.6% of children with isolated cleft palate.…”

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age

“…Factors specific to children with a cleft palate include the type of cleft, width of cleft, and palatal length. Interventional factors can impact speech outcome and include timing and technique of surgical repair, surgeon experience, volume of procedures, and the availability of routine multidisciplinary cleft palate team care (Mahoney et al, 2013;Golinko et al, 2016;Wu et al, 2017;Baillie & Sell, 2020).…”