title: Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate.
abstract: We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n=20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n=20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p=0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p=0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p=0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p=0.019). No patients in the Talmant group had an oronasal fistula (p<0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.
authors.affiliation: Département de chirurgie orthopédique et plastique pédiatrique, Hôpital Lapeyronie, CHRU Montpellier, France; Department of Oral and Maxillofacial Surgery, Dalhousie University, Halifax, Canada.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Doucet
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Captier
authors.forename: Hélène
authors.initials: H
authors.lastname: Baylon
authors.forename: Mélanie
authors.initials: M
authors.lastname: Verdeil
authors.forename: Michèle
authors.initials: M
authors.lastname: Bigorre
mesh_terms: D000367:Age Factors; D001184:Articulation Disorders / Q000209:etiology; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007805:Language Development Disorders / Q000209:etiology; D008046:Lip / Q000601:surgery; D008297:Male; D009668:Nose Diseases / Q000209:etiology; D016155:Oral Fistula / Q000209:etiology; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D013060:Speech / Q000502:physiology*; D013065:Speech Intelligibility / Q000502:physiology; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology
keywords: Cleft lip; Cleft palate; Intravelar veloplasty; Speech; Surgical technique