The Impact of Maxillary Osteotomy on Fricatives in Cleft Lip and Palate: A Perceptual Speech and Acoustic Study

Abstract

<b><i>Introduction:</i></b> Abnormal facial growth is a recognized outcome in cleft lip and palate (CLP), resulting in a concave profile and a class III occlusal status. Maxillary osteotomy (MO) is undertaken to correct this facial deformity, and the surgery can impact speech articulation, although the evidence remains limited and ill-defined for the CLP population. <b><i>Aims:</i></b> The aim of the study was to investigate the impact of MO on the production of the fricatives /f/ and /s/, using perceptual and acoustic analyses, and to explore the nature of speech changes. <b><i>Methods:</i></b> Twenty participants with CLP were seen 0–3 months pre-operatively (T1) and 3 months (T2) and 12 months (T3) after MO. A normal group (<i>N</i> = 20) was similarly recruited. Perceptual speech data was collected according to a validated framework and ratings made on audio and audio-video recordings (VIDRat). Spectral moments were centre of gravity (CG), standard deviation (SD), skewness (SK) and kurtosis (KU). Reliability studies were carried out for all speech analyses. <b><i>Results:</i></b> For the CLP group, VIDRat identified dentalization/interdentalization as the main type of pre-operative error for /s/ with a statistically significant improvement over time, χ<sup>2</sup>(2) = 6.889, <i>p</i> = 0.032. Effect sizes were medium between T1 and T3 (<i>d</i> = 0.631) and small between T2 and T3 (<i>d</i> = 0.194). For the acoustic data, effect sizes were similarly medium between T1 and T2 (e.g., SK, /f/ <i>d</i> = 0.579, /s/ <i>d</i> = 0.642) and small between T1 and T3 across all acoustic parameters. Independent <i>t</i> tests showed mainly statistically significant differences between both groups at all time points with large effect sizes (e.g., T2 CG, <i>t</i> = –4.571, <i>p</i> < 0.001, <i>d =</i>1.581), indicating that /s/ was not normalized post-operatively. For /f/, differences tended to be at T1 with large effect sizes (e.g., CG, <i>t</i> = –2.307, <i>p</i> = 0.028, <i>d</i> = 0.797), reflecting normalization. <b><i>Conclusions and Implications:</i></b> This is the first speech acoustic study on /f/ for individuals with CLP undergoing MO. The surgery has a positive impact on /f/ and /s/, which appear to stabilize 3 months post-operatively. Speech changes are an automatic and a direct consequence of the physical changes brought about by MO, effecting articulatory re-organization. The results of the study have direct clinical implications for the clinical care pathway for patients with CLP undergoing MO.

Função velofaríngea após avanço cirúrgico da maxila em pacientes com fissura labiopalatina: 20 anos de experiência no HRAC-USP

“…Alguns estudos evidenciaram fatores de risco para o aparecimento ou o agravamento de disfunção velofaríngea (DVF), tais como, a magnitude de avanço maxilar, dimensão da área do orifício velofaríngeo, hipernasalidade e incompetência velofaríngea prévia (TSANG et al, 2022). No entanto, variações no desenho dos estudos têm mostrado pouca concordância na literatura com respeito aos fatores de risco pré-operatórios mais importantes.…”

“…Objetivo: Investigar o efeito da Cirurgia Ortognática (CO) com avanço de maxila sobre a função velofaríngea (FVF) de pacientes operados ao longo de 20 anos. Apesar dos benefícios destas osteostomias no que se refere aos aspectos estéticos, respiratórios e oclusais, podem ocorrer prejuízos na fala como consequência da deterioração da função velofaríngea 4 .Alguns autores investigaram diferentes variáveis como por exemplo, tipo de fissura e quantidade de avanço maxilar afim de identificar fatores preditivos do aparecimento da disfunção velofaríngea utilizando, para tanto, variados métodos de análise, como, avaliação perceptiva de fala combinadas ou não a exames instrumentais (nasometria, rinomanometria e videofluoroscopia) e, análises cefalométricas por meio de telerradiografias e tomografias computadorizadas 2,5,6 .…”