Intravelar veloplasty in cleft lip, alveolus and palate and outcome of speech and language acquisition: a prospective study.
BACKGROUND
Speech and language acquisition are major, important criteria in the treatment outcomes of cleft lip and palate patients. A generally accepted and definitive treatment protocol regarding surgical techniques and the time schedule does not yet exist. In the world literature, there are reports of velo-pharyngeal insufficiency rates between 7 and 30%.


OBJECTIVE
In a prospective study, all children aged 312 months with cleft lip, alveolus and palate, or cleft palate only, underwent an intravelar veloplasty. Follow-up monitoring consisted of frequent clinical linguistic checks and supervision of language development without a planned intention of articulation therapy before the age of about 5 years.


RESULTS
Three hundred and ninety-seven children with non-syndromic clefts were included in this study, the youngest being 8-year old. Sixty children (15%) showed deviations in language and speech acquisition. From these, 56 (14%) had received articulation therapy after the 5th birthday. From these 56 children, 45 had overcome their problems with speech therapy alone whereas 11 (3%) needed a velo-pharyngeoplasty.


CONCLUSIONS
Although these results are much better than those reported in other cohorts, some children still have velo-pharyngeal incompetence for no apparent reason. One possible explanation might be surgical, since on occasions, the intravelar muscle bundle is divided into two parts and the palato-pharyngeal part runs isolated more laterally and can be missed during reconstruction and retropositioning.
Bitter
Klaus
K
Department of Maxillo-Facial Plastic Surgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. k.bitter@em.uni-frankfurt.de
Wegener
Carla
C
Gomille
Nadine
N
D000539:Alveolar Process / Q000002:abnormalities*; D002648:Child; D002663:Child Language; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D002985:Clinical Protocols; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007804:Language Development; D016015:Logistic Models; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery; D011446:Prospective Studies; D013060:Speech / Q000502:physiology*; D013070:Speech Therapy; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery