“Is there a relationship between palatal asymmetry and early speech outcomes in children with isolated cleft palate after double opposing Z-plasty?”

Abstract

left palate occurs because of failure of the palatal shelves to fuse. It is the most common congenital craniofacial deformity. 1 The management of cleft palate aims to address several issues, including oral feeding, speech, airway, and facial growth, and most importantly, achieving normal speech. Velopharyngeal insufficiency can occur as a result of inadequate velum closure against the pharyngeal walls, resulting in hypernasality and nasal air emission. 2 In most Background: Although some cleft palates show asymmetric palatal shelf length and/or width intraoperatively, the relationship between palate asymmetry and speech outcomes has not been fully investigated. Methods: This study retrospectively reviewed 234 patients who underwent double-opposing Z-plasty (DOZ) for isolated cleft palate (Veau class I and II). Speech outcomes were analyzed to evaluate the association with width and length discrepancy of the palatal shelves using multiple logistic regression adjusting for patient age. Results:The mean age at repair was 14.2 ± 5.26 months. The mean palatal shelf width and length differences were 0.87 ± 0.97 mm and 1.63 ± 1.61 mm, respectively. The mean age at initial and follow-up assessment was 37.6 ± 5.70 months (n = 234) and 66.2 ± 8.81 months (n = 120), respectively. Multivariate logistic regression analysis of initial speech outcomes showed odds ratios in width discrepancy of 1.67 (P = 0.0703), 1.59 (P = 0.0104), and 2.01 (P = 0.0051) for nasal emission, hypernasality, and compensatory articulation, respectively. Additional analysis including follow-up outcomes also revealed that width discrepancy of the palatal shelves had higher odds ratios for nasal emission, hypernasality, and compensatory articulation (OR, 1.49, P = 0.0406; OR, 1.36; P = 0.0660; and OR, 1.65; P = 0.0170, respectively). There was no association between length discrepancy and all speech abnormalities. Conclusions: Greater discrepancies in palatal shelf width, rather than in length, were associated with poorer speech outcomes after DOZ. The authors suggest that DOZ is effective for longitudinally asymmetric cleft palates. (Plast.