Download PDF
CC BY 4.0 · Arch Plast Surg 2024; 51(04): 378-385
DOI: 10.1055/s-0044-1787002
Pediatric/Craniomaxillofacial/Head & Neck
Original Article

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate

Mona Haj 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
S.N. Hakkesteegt 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
H.G. Poldermans 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
H.H.W. de Gier 
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
S.L. Versnel 
3   Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
E.B. Wolvius 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG).

Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively.

Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% (p < 0.001). Grimacing decreased in 27% (p = 0.015). Articulation disorders remained present in 85% (p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively (p < 0.001).

Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Keywords

cleft lip with or without cleft palate - cleft palate - speech - hard palate closure - alveolar bone grafting

Authors' Contributions

All Authors contributed to; (1) substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Ethical Approval

Since subjects are not being subjected to any handling, nor are there rules of human behavior being imposed, Institutional Review Board Approval was waived by the ethical committee of the hospital (MEC-2017-400).


Patient Consent

Not Applicable.




Publication History

Received: 03 August 2023

Accepted: 09 April 2024

Article published online:
14 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Fox D, Lynch J, Brookshire B. Selected developmental factors of cleft palate children between two and thirty-three months of age. Cleft Palate J 1978; 15 (03) 239-245
    PubMedGoogle Scholar
  • 2 Kummer AW. Speech evaluation for patients with cleft palate. Clin Plast Surg 2014; 41 (02) 241-251
    CrossrefPubMedGoogle Scholar
  • 3 Kummer AW, Briggs M, Lee L. The relationship between the characteristics of speech and velopharyngeal gap size. Cleft Palate Craniofac J 2003; 40 (06) 590-596
    CrossrefPubMedGoogle Scholar
  • 4 Kummer AW. Speech therapy for errors secondary to cleft palate and velopharyngeal dysfunction. Semin Speech Lang 2011; 32 (02) 191-198
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Chapman KL. Phonologic processes in children with cleft palate. Cleft Palate Craniofac J 1993; 30 (01) 64-72
    CrossrefPubMedGoogle Scholar
  • 6 Chapman KL. Is presurgery and early postsurgery performance related to speech and language outcomes at 3 years of age for children with cleft palate?. Clin Linguist Phon 2004; 18 (4-5): 235-257
    CrossrefPubMedGoogle Scholar
  • 7 Shaye D. Update on outcomes research for cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg 2014; 22 (04) 255-259
    CrossrefPubMedGoogle Scholar
  • 8 Lohmander-Agerskov A. Speech outcome after cleft palate surgery with the Göteborg regimen including delayed hard palate closure. Scand J Plast Reconstr Surg Hand Surg 1998; 32 (01) 63-80
    CrossrefPubMedGoogle Scholar
  • 9 Kelly SN, Shearer J. Appearance and speech satisfaction and their associations with psychosocial difficulties among young people with cleft lip and/or palate. Cleft Palate Craniofac J 2020; 57 (08) 1008-1017
    CrossrefPubMedGoogle Scholar
  • 10 Al-Omari I, Millett DT, Ayoub AF. Methods of assessment of cleft-related facial deformity: a review. Cleft Palate Craniofac J 2005; 42 (02) 145-156
    CrossrefPubMedGoogle Scholar
  • 11 de Ladeira PR, Alonso N. Protocols in cleft lip and palate treatment: systematic review. Plast Surg Int 2012; 2012: 562892
    PubMedGoogle Scholar
  • 12 Semb G, Shaw WC. Facial growth after different methods of surgical intervention in patients with cleft lip and palate. Acta Odontol Scand 1998; 56 (06) 352-355
    CrossrefPubMedGoogle Scholar
  • 13 Wlodarczyk JR, Brannon B, Munabi NCO. et al. A meta-analysis of palatal repair timing. J Craniofac Surg 2021; 32 (02) 647-651
    CrossrefPubMedGoogle Scholar
  • 14 Van Lierde KM, Monstrey S, Bonte K, Van Cauwenberge P, Vinck B. The long-term speech outcome in Flemish young adults after two different types of palatoplasty. Int J Pediatr Otorhinolaryngol 2004; 68 (07) 865-875
    CrossrefPubMedGoogle Scholar
  • 15 Sell D. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord 2005; 40 (02) 103-121
    CrossrefPubMedGoogle Scholar
  • 16 Meijer M. Afwijkingen. WlvdNVvSeC. Het logopedisch onderzoek van kinderen, geboren met een schisis. ZonMW. 2003
    Google Scholar
  • 17 Laowansiri U, Behrents RG, Araujo E, Oliver DR, Buschang PH. Maxillary growth and maturation during infancy and early childhood. Angle Orthod 2013; 83 (04) 563-571
    CrossrefPubMedGoogle Scholar
  • 18 Cornelissen AM, Maltha JC, Von den Hoff HW, Kuijpers-Jagtman AM. Palatal mucoperiosteal wound healing in the rat. Eur J Oral Sci 1999; 107 (05) 344-351
    CrossrefPubMedGoogle Scholar
  • 19 Li J, Johnson CA, Smith AA. et al. Disrupting the intrinsic growth potential of a suture contributes to midfacial hypoplasia. Bone 2015; 81: 186-195
    CrossrefPubMedGoogle Scholar
  • 20 Voshol IE, van der Wal KG, van Adrichem LN, Ongkosuwito EM, Koudstaal MJ. The frequency of Le Fort I osteotomy in cleft patients. Cleft Palate Craniofac J 2012; 49 (02) 160-166
    CrossrefPubMedGoogle Scholar
  • 21 Good PM, Mulliken JB, Padwa BL. Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J 2007; 44 (04) 396-401
    CrossrefPubMedGoogle Scholar
  • 22 Daskalogiannakis J, Mehta M. The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate. Cleft Palate Craniofac J 2009; 46 (05) 498-502
    CrossrefPubMedGoogle Scholar
  • 23 Rosenstein S, Kernahan D, Dado D, Grasseschi M, Griffith BH. Orthognathic surgery in cleft patients treated by early bone grafting. Plast Reconstr Surg 1991; 87 (05) 835-892 , discussion 840–842
    CrossrefPubMedGoogle Scholar
  • 24 DeLuke DM, Marchand A, Robles EC, Fox P. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. J Oral Maxillofac Surg 1997; 55 (07) 694-697 , discussion 697–698
    CrossrefPubMedGoogle Scholar
  • 25 Lohmander A, Friede H, Lilja J. Long-term, longitudinal follow-up of individuals with unilateral cleft lip and palate after the Gothenburg primary early veloplasty and delayed hard palate closure protocol: speech outcome. Cleft Palate Craniofac J 2012; 49 (06) 657-671
    CrossrefPubMedGoogle Scholar
  • 26 Kappen IFPM, Bittermann D, Janssen L. et al. 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. Arch Plast Surg 2017; 44 (03) 202-209
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Hortis-Dzierzbicka M, Radkowska E, Fudalej PS. Speech outcomes in 10-year-old children with complete unilateral cleft lip and palate after one-stage lip and palate repair in the first year of life. J Plast Reconstr Aesthet Surg 2012; 65 (02) 175-181
    CrossrefPubMedGoogle Scholar
  • 28 Kummer AW. Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management. 4th ed. Burlington, MA:: Jones & Bartlett Learning; 2018
    Google Scholar
  • 29 Haque S, Alam MK, Khamis MF. Factors responsible for unfavorable dental arch relationship in non syndromic unilateral cleft lip and palate children. J Clin Pediatr Dent 2017; 41 (03) 236-242
    CrossrefPubMedGoogle Scholar
  • 30 Noordhoff MS, Kuo J, Wang F, Huang H, Witzel MA. Development of articulation before delayed hard-palate closure in children with cleft palate: a cross-sectional study. Plast Reconstr Surg 1987; 80 (04) 518-524
    CrossrefPubMedGoogle Scholar
  • 31 Liao YF, Yang IY, Wang R, Yun C, Huang CS. Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate. Plast Reconstr Surg 2010; 125 (05) 1503-1510
    CrossrefPubMedGoogle Scholar
  • 32 Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 1987; 24 (01) 5-77
    PubMedGoogle Scholar
  • 33 Shaw WC, Semb G, Nelson P. et al. The Eurocleft project 1996-2000: overview. J Craniomaxillofac Surg 2001; 29 (03) 131-140 , discussion 141–142
    CrossrefPubMedGoogle Scholar
  • 34 Perko MA. Two-stage closure of cleft palate (progress report). J Maxillofac Surg 1979; 7 (01) 46-80
    PubMedGoogle Scholar
  • 35 Mommaerts MY, Kablan F, Sheth S, Laster Z. Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair. J Maxillofac Sur 2003; 31 (04) 209-214
    Google Scholar
  • 36 Arora J, Haj M. Case Study: Implementing ICHOM's Standard Sets of Outcomes – Erasmus Medical Centre in the Netherlands. London, UK: International Consortium for Health Outcomes Measurement (ICHOM). 2016 . Accessed May 1, 2024 at: http://www.ichom.org/news/case-study-implementing-ichoms-standard-sets-of-outcomes-erasmus-medical-centre-in-the-netherlands/
    PubMedGoogle Scholar
  • 37 Haj M, de Gier HHW, van Veen-van der Hoek M. et al. [Improving care for cleft lip and palate patients: uniform and patient-orientated outcome measures]. Ned Tijdschr Tandheelkd 2018; 125 (02) 70-75
    CrossrefPubMedGoogle Scholar