title: Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty.
abstract: OBJECTIVE
  This study was performed to investigate speech outcomes after three different types of palatoplasty for the same cleft type. The objective of this study was to investigate the surgical techniques that are essential for normal speech on the basis of each surgical characteristic.
  
  
  METHODS
  Thirty-eight consecutive nonsyndromic patients with unilateral complete cleft of the lip, alveolus, and palate were enrolled in this study. Speech outcomes, i.e., nasal emission, velopharyngeal insufficiency, and malarticulation after one-stage pushback (PB), one-stage modified Furlow (MF), or conventional two-stage MF palatoplasty, were evaluated at 4 (before intensive speech therapy) and 8 (after closure of oronasal fistula/unclosed hard palate) years of age.
  
  
  RESULTS
  Velopharyngeal insufficiency at 4 (and 8) years of age was present in 5.9% (0.0%), 0.0% (0.0%), and 10.0% (10.0%) of patients who underwent one-stage PB, one-stage MF, or two-stage MF palatoplasty, respectively. No significant differences in velopharyngeal function were found among these three groups at 4 and 8 years of age. Malarticulation at 4 years of age was found in 35.3%, 10.0%, and 63.6% of patients who underwent one-stage PB, one-stage MF, and two-stage MF palatoplasty, respectively. Malarticulation at 4 years of age was significantly related to the presence of a fistula/unclosed hard palate (P<0.01). One-stage MF palatoplasty that was not associated with postoperative oronasal fistula (ONF) showed significantly better results than two-stage MF (P<0.01). Although the incidences of malarticulation at 8 years of age were decreased in each group compared to at 4 years of age, the incidence was still high in patients treated with two-stage MF (45.5%). On the whole, there was a significant correlation between ONF/unclosed hard palate at 4 years of age and malarticulation at 8 years of age (P<0.05).
  
  
  CONCLUSIONS
  Appropriate muscle sling formation can compensate for a lack of retropositioning of the palate for adequate velopharyngeal closure. Early closure of the whole palate and the absence of a palatal fistula were confirmed to be essential for normal speech. To avoid fistula formation, multilayer repair of the whole palate may be critical.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Funayama
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Communication Disorders, Health Sciences University of Hokkaido, 2-5 Ainosato, Kita-ku, Sapporo 002-8072, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishizawa
authors.affiliation: Clinic of Stomatognathic Function, Center for Advanced Oral Medicine, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Mikoya
authors.affiliation: Okamoto Orthodontic Clinic, 3-25, Kita-1, Nishi-3, Chuo-ku, Sapporo 060-0001, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Department of Communication Disorders, Health Sciences University of Hokkaido, 2-5 Ainosato, Kita-ku, Sapporo 002-8072, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Imai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Murao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan. Electronic address: akihiko.oyama@mac.com.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oyama
mesh_terms: D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016155:Oral Fistula / Q000150:complications; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D013064:Speech Disorders / Q000209:etiology*; D013068:Speech Production Measurement; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery
keywords: Cleft palate; Comparative study; Oronasal fistula; Palatoplasty; Speech outcome