Speech Results after One-Stage Palatoplasty with or without Muscle Reconstruction for Isolated Cleft Palate

2010 ◽  
Vol 47 (1) ◽  
pp. 92-103 ◽  
Author(s):  
Jill Nyberg ◽  
Liisi Raud Westberg ◽  
Erik Neovius ◽  
Ola Larson ◽  
Gunilla Henningsson
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Techniques ◽  
Perceptual Judgment ◽  
Cross Sectional ◽  
Minimal Incision ◽  
Primary Palate ◽  
Palate Repair ◽  
Incision Technique ◽  
Isolated Cleft Palate

Objective To investigate speech outcome between children with isolated cleft palate undergoing palatoplasty with and without muscle reconstruction and to compare speech outcomes between cleft and noncleft children. The number of subsequent velopharyngeal flaps was compared with respect to surgical techniques and cleft extent. Design Cross-sectional retrospective study. Participants One hundred four children aged 4 years, 0 months to 6 years, 0 months, 33 with isolated cleft of the soft palate, 53 with isolated cleft of the hard and soft palate, and 18 noncleft children. Interventions Two primary palate repair techniques: minimal incision technique (MIT) and minimal incision technique including muscle reconstruction (MITmr). Main Outcome Measures Perceptual judgment of seven speech parameters assessed on a five-point scale. Results No significant differences in speech outcomes were found between MIT and MITmr surgery groups. The number of velopharyngeal flaps was significantly lower after MITmr surgery compared to MIT surgery. The number of flaps was also significantly lower in children with cleft of the soft palate compared to children with cleft of the hard and soft palate. Children with cleft of the soft palate had significantly less glottal articulation and weak pressure consonants compared to children with cleft of the hard and soft palate. Conclusions The MITmr surgery technique was not significantly superior to the MIT technique regarding speech outcomes related to velopharyngeal competence, but had fewer velopharyngeal flaps, which is contradictory. Until a larger sample can be studied, we will continue to use MITmr for primary palate repair.

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

2002 ◽  
Vol 39 (4) ◽  
pp. 397-408 ◽  
Author(s):  
Christina Persson ◽  
Anna Elander ◽  
Anette Lohmander-Agerskov ◽  
Ewa Söderpalm
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Reference Group ◽  
University Hospital ◽  
Perceptual Judgment ◽  
Cross Sectional ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate ◽  
The Impact

Objective The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. Design A cross-sectional retrospective study. Setting A university hospital serving a population of 1.5 million inhabitants. Subjects Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. Interventions A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Main outcome Measures Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. Results The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. Conclusion Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Facial growth in patients with isolated cleft palate treated with minimal incision technique compared to a normal population—a cephalometric study at 10 and 16 years of age

2019 ◽  
Author(s):  
Konstantinos Parikakis ◽  
Ola Larson ◽  
Agneta Karsten
Keyword(s):  
Cleft Palate ◽  
Normal Population ◽  
Treated Group ◽  
Craniofacial Morphology ◽  
Control Group ◽  
Facial Growth ◽  
Minimal Incision ◽  
Lateral Cephalograms ◽  
Incision Technique ◽  
Isolated Cleft Palate

Summary Objective To evaluate the result of a novel palatoplasty (minimal incision technique) for closure of an isolated cleft palate (ICP) at 10 and 16 years of age, concerning facial growth, compared to a normal population. Subjects Treated group: 55 non-syndromic Caucasian children born with an ICP between 1987 and 2001. The children were treated surgically with a one-stage palatoplasty at a mean age of 13 months. Control group: 110 Caucasian children with normal occlusion with no history of clefts or orthodontic intervention. Method The treated children (25 boys, 30 girls) were matched (gender and age) with the children in the control group. A retrospective evaluation at 10 (mean 10.5) and 16 (mean 16.0) years of age was performed by analysis of lateral cephalograms. Fifteen variables were evaluated. Ninety-nine per cent confidence intervals were calculated. Two-way factorial ANOVA and mixed-model analysis were performed. Results Treated patients compared to the control group showed: at 10 years of age, smaller mandible (P = 0.001) and reduced posterior upper and total face heights (P ≤ 0.001); at 10 and 16 years of age, a retrognathic (P ≤ 0.001), smaller (P ≤ 0.006) and with an increased posterior inclination of the maxilla (P < 0.001), as well as a retrognathic mandible (P ≤ 0.006). Conclusion The craniofacial morphology at 10 and 16 years of age in patients born with an ICP and treated with the minimal incision technique differs compared to the morphology of a normal control group born without a cleft. Retrognathic maxillas and a smaller and posteriorly inclined maxilla were found in the treated group.

Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate—a cephalometric study at 5 and 10 years

2018 ◽  
Vol 41 (4) ◽  
pp. 420-427 ◽  
Author(s):  
Konstantinos Parikakis ◽  
Ola Larson ◽  
Agneta Karsten
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Mixed Model ◽  
Craniofacial Morphology ◽  
Consecutive Series ◽  
Face Height ◽  
Minimal Incision ◽  
Lateral Cephalograms ◽  
Upper Face ◽  
Isolated Cleft Palate

Summary Objective To compare differences in facial growth in patients with isolated clefts of the hard and/or soft palate treated with the minimal incision technique without (MI) or with muscle reconstruction (MMI). Subjects and method A consecutive series of 170 Caucasian children born with isolated cleft palate were studied. Individuals with other craniofacial malformations, apart from Pierre Robin sequence (PRS), were excluded. The patients were treated surgically with MI (n = 85) or MMI (n = 85) palatoplasty (mean age: 13 months) and divided further into two subgroups: clefts within the soft palate only (small cleft, n = 51) and within the hard and soft palate (big cleft, n = 119). A retrospective evaluation at 5 (mean 5.4) and 10 (mean 10.3) years was performed using lateral cephalograms. Twelve skeletal and one soft tissue measurement was evaluated. Both 95% and 99% confidence intervals were calculated, two-way ANOVA and mixed model analysis was performed including/excluding PRS. Results At 5 years, statistically significant increased inclination of the palatal plane in the big MMI cleft group (P < 0.01), increased posterior upper face height (P < 0.01), and longer mandibular length (P < 0.001) in the small MI cleft group was observed. At 10 years, statistically significant increased inclination of the palatal plane (P < 0.001), decreased posterior upper face height (P < 0.001), and longer palatal length (P < 0.01) was seen in the big MMI group. Limitations Retrospective single centre study, limited sample size, three surgeons. Conclusion Minor differences in craniofacial morphology were found between patients with isolated clefts treated with MI or MMI technique and between small and big cleft lengths.

Facial Growth at 5 and 10 Years After Veau-Wardill-Kilner Versus Minimal-Incision Technique Repair of Isolated Cleft Palate

2017 ◽  
Vol 55 (1) ◽  
pp. 79-87 ◽  
Author(s):  
Konstantinos Parikakis ◽  
Ola Larson ◽  
Margareta Larson ◽  
Agneta Karsten
Keyword(s):  
Retrospective Study ◽  
Cleft Palate ◽  
Consecutive Series ◽  
Pierre Robin Sequence ◽  
Facial Growth ◽  
Minimal Incision ◽  
Lateral Cephalograms ◽  
Incision Technique ◽  
Isolated Cleft Palate ◽  
Pierre Robin

Objective: To compare the Veau-Wardill-Kilner technique with the Minimal-Incision technique repair of isolated clefts of the hard and soft palate regarding facial growth at 5 and 10 years of age. Design: Retrospective study of lateral cephalograms. Setting: Hospital and university based. Patients: A consecutive series of 145 Caucasian nonsyndromic children born with isolated cleft palate between 1980 and 1996 were studied. Children with Pierre Robin sequence (PRS) were included in the study. The patients were divided into 4 groups: 2 groups regarding surgical technique and 2 groups regarding cleft length. Intervention: Veau-Wardill-Kilner or Minimal-Incision palatoplasty. Main Outcome Measures: Eleven skeletal and 1 soft tissue measurement were evaluated from lateral cephalograms taken at 5 and 10 years of age. Results: Only minor differences in cephalometric morphology were found between the Veau-Wardill-Kilner technique group and the Minimal-Incision technique group. Similar results were found independent of cleft length or the inclusion of PRS in the sample. Conclusion: The craniofacial cephalometric morphology at 5 and 10 years of age in patients with isolated cleft palate is similar between the Veau-Wardill-Kilner and the Minimal-Incision technique group.

A Closer Look at Delayed Primary Cleft Surgery and Unrepaired Cleft Lip and/or Palate in 5 UK Cleft Centers

2021 ◽  
pp. 105566562110217
Author(s):  
Sophie Butterworth ◽  
Clare Rivers ◽  
Marnie Fullarton ◽  
Colm Murphy ◽  
Victoria Beale ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Problems ◽  
Primary Surgery ◽  
The United Kingdom ◽  
Number Of Patients ◽  
Primary Palate ◽  
Palate Repair ◽  
Cleft Surgery

Background: There may be many reasons for delays to primary cleft surgery. Our aim was to investigate the age of children undergoing primary cleft lip or primary cleft palate repair in 5 cleft centers within the United Kingdom. Identify the reasons for delayed primary cleft lip repair (beyond 6 months) and delayed primary palate repair (beyond 13 months). Identify children who had a cleft lip and/or palate (CL±P) that was intentionally unrepaired and the reasons for this. Methods: A retrospective, multicenter review of patients born with a CL±P between December 1, 2012, and December 31, 2016. Three regional cleft centers, comprising of 5 cleft administrative units in the United Kingdom participated. Results: In all, 1826 patients with CL±P were identified. Of them, 120 patients had delayed lip repair, outside the expected standard of 183 days. And, 178 patients in total had delayed palate repair, outside the expected standard of 396 days. Twenty (1%) patients had an unrepaired cleft palate. Conclusions: This large retrospective review highlights variations between centers regarding the timing of lip and palate surgery and details the reasons stated for delayed primary surgery. A small number of patients with an unrepaired cleft palate were identified. All had complex medical problems or comorbidities listed as a reason for the decision not to operate and 50% had a syndromic diagnosis. The number of patients receiving delayed surgery due to comorbidities, being underweight or prematurity, highlights the importance of the cleft specialist nurse and pediatrician within the cleft multidisciplinary team.

Impact of cleft palate repair on speech and development of dentoalveolar deformities

2021 ◽  
Vol 16 (3) ◽  
pp. 47-53
Author(s):  
Yu.V. Stebeleva ◽  
◽  
Ad.A. Mamedov ◽  
Yu.O. Volkov ◽  
A.B. McLennan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Normal Functioning ◽  
Primary Surgery ◽  
Cleft Palate Repair ◽  
Congenital Cleft ◽  
Palate Repair ◽  
Late Postoperative Period

Surgical repair of cleft palate is quite difficult because it aims not only to eliminate the anatomical defect of the palate, but also to ensure normal functioning, including speech. Moreover, successful surgery implies no or minimal deformation of the middle face that can be corrected in the late postoperative period. No doubt that primary surgery (both in terms of technique and time) is crucial for further growth and development of the maxilla. However, surgical techniques and the age of primary cleft palate repair vary between different clinics, which makes this literature review highly relevant. Key words: cleft palate repair, cleft palate, congenital cleft lip and palate

scholarly journals Corelation Of Parents’ Profiles Of Children With Late Cleft Repair In Surabaya Cleft Lip And Palate Centre (January 2015 – December 2017)

2021 ◽  
Vol 5 (1) ◽  
pp. 18
Author(s):  
Laras Puspita Ningrum ◽  
Iswinarno Doso Saputro ◽  
Lobredia Zarasade
Keyword(s):  
Cleft Palate ◽  
Primary Care Physicians ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Speech Disorders ◽  
Education Level ◽  
Optimal Time ◽  
Cross Sectional ◽  
Cleft Palate Repair ◽  
Palate Repair

Background : Optimal time of  Cleft palate repair is during the 10 to 12  month of age. In this time produce far natural results in terms of speech because it enabled the maturation of scar tissue postoperatively. The soft palate must function properly before the patient starts learning to talk, otherwise speech disorders such as persistent rhinolalia aperta might arise. In pediatric patients, the role of parents is very important on adherence to therapy.Methods: This is a cross-sectional study. The first study group was parents of patients who had surgical repair before two years old and the second group was the parents of patients who had repair after two years old. We compared age, monthly income, education level, number of children, and residential distance from Surabaya of the two groups.Results : The data of this study were obtained from the medical records of patients with cleft lip surgery at CLP Center Surabaya in 2015th – 2017th with total of 358 patients, 172 were female and 186 were male. 52 patients with delayed cleft palate surgery. Patients’ parents in both groups were mostly 31-40 years old, were high school graduated, has one child, earned less than 1.5 million rupiah a month, and lived less than 100 kms from Surabaya. From the statistical results, parent’s income has the strongest correlation with the patient’s age in cleft palate surgery (-2.7). A negative coefficient means that the less parent’s income, the more patient likely had delayed cleft palate surgery. While other factors found weak and very weak correlations.Conclusions: The results form patient's parents' interview, concluded that besides economic factors, the lack of information cleft palate treatment is the key factors that contributed to the delay of cleft palate repair. The education level does not affect the delay in cleft palate surgery, because even in high educated parents, sometimes they don’t understand the stages of cleft lip and palate treatment. This study emphasized the necessity to educate about the stages of surgery by primary care physicians, to minimize delays.

scholarly journals Long-term Speech Outcomes of Cleft Palate Repair in Robin Sequence versus Isolated Cleft Palate

2021 ◽  
Vol 9 (1) ◽  
pp. e3351
Author(s):  
Robrecht J. H. Logjes ◽  
Susanna Upton ◽  
Bryce A. Mendelsohn ◽  
Ryan K. Badiee ◽  
Corstiaan C. Breugem ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Robin Sequence ◽  
Sequence Versus ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Isolated Cleft Palate

The State of the Art in Cleft Palate Surgery

2000 ◽  
Vol 37 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Don Larossa
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
State Of The Art ◽  
Historical Context ◽  
Current Understanding ◽  
Multiple Methods ◽  
Advantages And Disadvantages ◽  
Palate Repair

Overview This update focuses on current practices and controversies in surgical repair of the hard and soft palate posterior to the alveolus. Our current understanding of the advantages and disadvantages of presurgical active and passive manipulation of the hard palate shelves including the use of periosteoplasty is reviewed. The evolution of the multiple methods of repair of the hard and soft palate is given in a historical context along with a discussion of the concerns about timing of palate repair.

scholarly journals A Retrospective Comparison of Conventional versus Transverse Mini-Incision Technique for Carpal Tunnel Release

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
İsmail Gülşen ◽  
Hakan Ak ◽  
Gökhan Evcılı ◽  
Özlem Balbaloglu ◽  
Enver Sösüncü
Keyword(s):  
Postoperative Complications ◽  
Carpal Tunnel Release ◽  
Surgical Techniques ◽  
Conventional Technique ◽  
Daily Activities ◽  
Incision Site ◽  
Minimal Incision ◽  
Retrospective Comparison ◽  
Incision Technique ◽  
Mini Incision

Background. In this retrospective study, we aimed to compare the results of two surgical techniques, conventional and transverse mini-incision. Materials and Methods. 95 patients were operated between 2011 and 2012 in Bitlis State Hospital. 50 patients were operated with conventional technique and 45 of them were operated with minimal transverse incision. Postoperative complications, incision site problems, and the time of starting to use their hands in daily activities were noted. Results. 95 patients were included in the study. The mean age was 48. 87 of them were female and 8 were male. There was no problem of incision site in both of the two surgical techniques. Only in one patient, anesthesia developed in minimal incision technique. The time of starting to use their hands in daily activities was 22,2 days and 17 days in conventional and minimal incision technique, respectively. Conclusion. Two surgical techniques did not show superiority to each other in terms of postoperative complications and incision site problems except the time of starting to use their hands in daily activities.

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