title: Long term speech outcomes following late cleft palate repair using the modified Furlow technique.
abstract: OBJECTIVE
  Published reports and previous studies from our institution have reported worse overall speech results, including significantly higher rates of persistent articulation errors, in patients undergoing palatoplasty at age >18 months. This study further investigates the effects of late repair on long term speech outcomes.
  
  
  METHODS
  A retrospective review was performed of non-syndromic patients undergoing primary palatoplasty at age >18 months between 1980 and 2006 at our institution. Longitudinal speech results were compared based on reason for late repair and age at repair.
  
  
  RESULTS
  Forty-one patients were greater than 18 months of age at the time of palatoplasty, and 24 fit criteria for longitudinal data analysis. There was a statistically significant improvement in nasality scores at Time Point 1 for international adoptees compared to the non-adopted population (p=0.04). Patients with submucosal clefts were found to have significantly less severe nasal emission scores at Time Point 1 compared to those with overt clefts (p=0.04), but not at Time Point 2. There were no significant differences between scores if repair was performed between 18 and 36 months or >36 months, nor any difference in incidence of articulation errors between subgroups of patients with late repair at either Time Point.
  
  
  CONCLUSIONS
  Our experience demonstrates that cleft palate repair after 18 months of age is associated with a significantly increased incidence of articulation errors associated with VPI, irrespective of reason for late repair, highlighting the persistence of learned compensatory behaviors in speech and the importance of proceeding with early repair.
authors.affiliation: Mount Sinai Hospital's Division of Plastic and Reconstructive Surgery, New York City, NY, United States.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Pasick
authors.affiliation: The Children's Hospital of Philadelphia's Division of Plastic and Reconstructive Surgery, Philadelphia, PA, United States.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Shay
authors.affiliation: Johns Hopkins Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Stransky
authors.affiliation: The Children's Hospital of Philadelphia's Division of Plastic and Reconstructive Surgery, Philadelphia, PA, United States.
authors.forename: Cynthia B
authors.initials: CB
authors.lastname: Solot
authors.affiliation: The Children's Hospital of Philadelphia's Division of Plastic and Reconstructive Surgery, Philadelphia, PA, United States.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Cohen
authors.affiliation: The Children's Hospital of Philadelphia's Division of Plastic and Reconstructive Surgery, Philadelphia, PA, United States. Electronic address: jacksono@email.chop.edu.
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D000300:Adoption; D000367:Age Factors; D001184:Articulation Disorders / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013060:Speech; D013997:Time Factors; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology*; D014833:Voice Quality
keywords: Articulation errors; Cleft palate; Late cleft palate repair; Palatoplasty; Speech outcomes; Velopharyngeal insufficiency