The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

Abstract

Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate. Design: Retrospective case series. Setting: Tertiary care children’s hospital. Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed. Interventions: Palatoplasty. Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery. Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty. Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.

Abordagem fonoaudiológica em pacientes com fissura labiopalatal em serviço especializado de alta complexidade na região oeste do Paraná

“…Afirma-se portanto, que bons resultados no desenvolvimento da fala também dependem de um bom resultado cirúrgico (Hosseinbad et al, 2015;Shaffer et al, 2020) e a interlocução da equipe cirúrgica com a fonoaudiologia é fundamental para o sucesso da abordagem integral, necessária ao paciente.…”

Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature

“…Formal evaluation of such practices in plastic surgery and related specialties remains a challenge given the paucity of level I and II evidence (Ariyan et al, 2015;Brignardello-Petersen et al, 2015;Naimi-Akbar et al, 2018;Habib et al, 2019;Delaplain et al, 2020). This task is particularly challenging in the cleft population as outcomes are influenced by multiple factors, including cleft size and type (Bykowski et al, 2015;, surgical timing (Eliason et al, 2020;Shaffer et al, 2020), and patient/caregiver socioeconomic status and access to care (Bennett et al, 2018).…”

Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?

“…Prior studies of CP repair have suggested that surgery prior to 13 months of age was associated with improved speech outcomes. 12,13 Many factors contribute to delays in surgical intervention in patients with CP, including the aforementioned patient factors as well as systems-based factors such as operative scheduling and access to care. Last, the increased speech error rates identified in these patients may be related to uncaptured patient factors (eg, developmental delay) that would have correlated with worse speech outcomes regardless of timing of repair.…”