title: Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure.
abstract: OBJECTIVE
  In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that one-stage palate closure leads to less surgical impact on the child probably contributed to the choice for this procedure in most cleft centers. However, no previous research has verified this assumption. The aim of the present study is to compare surgical impact and speech outcome at 2.5 years of age between children who underwent either one- or early two-stage palate closure.
  
  
  METHODS
  Patients underwent either one-stage palate closure between 2007 and 2010 at a median age of 10.8 months (group 1, n=24) or early two-stage closure before 2007 at median ages of 10.4 and 18.2 months, respectively (group 2, n=24). Surgical impact was compared between the two groups by means of duration of surgery, length of hospital stay and number of post-operative complications. Speech outcome was compared by means of resonance problems, nasal air emission, articulation and intelligibility, all assessed at a median age of 2.5 years.
  
  
  RESULTS
  The one-stage closure group showed significantly shorter duration of surgery and length of hospital stay (p<0.001 and p=0.001, respectively) and significantly better articulation (p=0.029) than the early two-stage closure group.
  
  
  CONCLUSIONS
  One-stage palate closure is preferable over early two-stage palate closure with regard to surgical impact and speech development. More extensive, prospective studies, in which maxillary growth is taken into account, should be conducted.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, The Netherlands. Electronic address: a.c.randag@umcg.nl.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Randag
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, The Netherlands. Electronic address: m.dreise@umcg.nl.
authors.forename: Marieke M
authors.initials: MM
authors.lastname: Dreise
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, The Netherlands. Electronic address: m.ruettermann@umcg.nl.
authors.forename: Mike
authors.initials: M
authors.lastname: Ruettermann
mesh_terms: D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007804:Language Development; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013068:Speech Production Measurement
keywords: Cleft palate; One-stage palate closure; Speech outcome; Surgical impact; Two-stage palate closure