Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

Kappen, Isabelle Francisca Petronella Maria; Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal Wb; Haverkamp, Sarah; Wilde, Hester de; Heul, Marise van der; Specken, Tom F. J. M. C.; Koole, R.; Kon, Moshe; Breugem, Corstiaan C.; Molen, Aebele B. Mink van der

doi:10.5999/aps.2017.44.3.202

Cited by 26 publications

(30 citation statements)

References 23 publications

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“…In these patients, surgical intervention is considered to be the optimal treatment. Because the timing of surgery is generally considered to be an important factor that determines speech outcomes, children who received early surgical intervention had better outcomes [11][12][13][14]. Several studies have suggested that a younger age leads to better results of surgery in children with SMCP, but research on the different effects of treatment depending on the timing of surgery remains insufficient.…”

Section: Clinical Interventions and Speech Outcomes For Individuals Wmentioning

confidence: 99%

Clinical interventions and speech outcomes for individuals with submucous cleft palate

Jung

Koh

et al. 2020

Arch Plast Surg

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Background This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement.Methods This retrospective study included 72 children diagnosed with SMCP between 2008 and 2016. The evaluation criteria were the age of the initial visit, total number of visits, age at the end of treatment, speech problems, resonance problems, and speech therapy.Results Children with SMCP first visited the hospital at an average age of 34.32 months, and speech problems were identified at an average age of 48.53 months. Out of 72 children, 46 underwent surgery at an average age of 49.74 months. Four of these children required secondary surgery at an average age of 83.5 months. Among the children who underwent surgery before 3 years of age, 70% exhibited articulation improvements, with mild-to-moderate hypernasality. Articulation improvements showed no statistically significant differences according to age at the time of surgery. However, children who underwent surgery before 4 years had a better hypernasality rating than those who underwent surgery after 4 years of age.Conclusions Children with SMCP tend to undergo delayed treatment because the anatomical symptoms in some children with SMCP are unclear, and surgical interventions are considered only after speech problems are clarified. Starting interventions as early as possible reduces the likelihood of receiving secondary surgery and speech therapy, while increasing expectations for positive speech function at the end.

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Section: Clinical Interventions and Speech Outcomes For Individuals Wmentioning

confidence: 99%

Clinical interventions and speech outcomes for individuals with submucous cleft palate

Jung

Koh

et al. 2020

Arch Plast Surg

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“…The previously discussed study by Liao et al (2010), although finding restricted maxillary growth in single-stage patients, also reported a velopharyngeal function level of “adequate” in 48% of single-stage patients, as compared to 22% of 2-stage repair. Several small studies reported increased levels of hypernasality and nasal emission among patients with 2-stage CP (Pradel et al, 2009; Kappen et al, 2017). One reported the 2-stage group experiences a pharyngoplasty rate of 42% (Kappen et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair

McCrary

Pollard

Torrecillas

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To evaluate the association of 2-stage cleft palate (CP) surgery on velopharyngeal insufficiency (VPI) incidence, speech surgeries, and cleft-related surgical burden. Design: Retrospective cohort with follow-up of 4 to 19 years. Setting: Academic, tertiary children’s hospital. Patients: Patients who underwent CP surgery between 2000 and 2017. Exclusions included submucous CP or age at last contact under 3.9. Interventions: Cleft palate surgery, completed in either a single-stage or 2-stage repair. Main Outcome Measure(s): Rates of VPI diagnosis and speech surgery and total cleft surgeries; t tests, tests of proportion, and linear and logistic regression were performed. Total cleft-related surgeries were examined in a subset (n = 418) of patients with chart reviews. Results: A total of 1047 patients were included; 59.6% had 2-stage CP repair, 40.4% had single-stage repair. Approximately 32% of children with 2-stage CP repair were diagnosed with VPI, as opposed to 22% of single-stage patients ( P < .001). Children with 2-stage CP repair were 1.8 times as likely to be diagnosed with VPI ( P < .001). Speech surgery rates were similar across groups. Patients who had 2-stage repair received an average of 2.3 more cleft-related procedures, when excluding prosthesis management procedures. Conclusion: Our data show an increased risk of VPI diagnosis and increased surgical burden among patients receiving 2-stage CP repair.

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“…Most eligible studies (91.3%) were published in the past 2 decades 4,6,7,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 2). Most studies were conducted in Europe (43.5%) and 26.2% were conducted in the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…38,39 According to the literature, approximately 50% of patients born with CP develop problems with speech at 3 years of age, even if they underwent palatoplasty. 20,40 Eleven studies (10 retrospective cohort studies 12,14,23-27,30-32 and 1 prospective cohort study 16 ) examined the association between speech and palatal closure technique (Table 6). Dissaux et al 30 compared the VWK straight-line palatoplasty with the Sommerlad IVVP.…”

Section: Speechmentioning

confidence: 99%

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Téblick

Ruymaekers

Casteele

et al. 2019

Journal of Oral and Maxillofacial Surgery

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Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes. Materials and Methods: A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed. Results: Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-toY pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared. Conclusions: The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-toY pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.

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Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

Cited by 26 publications

References 23 publications

Clinical interventions and speech outcomes for individuals with submucous cleft palate

Clinical interventions and speech outcomes for individuals with submucous cleft palate

Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

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