title: Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia.
abstract: OBJECTIVE
  To assess speech outcomes after anterior maxillary distraction (AMD) in patients with cleft-related maxillary hypoplasia.
  
  
  METHODS
  Fifty-eight patients at least 10 years old with cleft-related maxillary hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant.
  
  
  RESULTS
  Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant (P ≤ .001).
  
  
  CONCLUSIONS
  AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment.
authors.affiliation: Project Director, Dr Jeyashekaran Centre for Cleft Care, Dr Jeyashekaran Hospital, Nagercoil; Director, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India. Electronic address: sunilrichardson145@gmail.com.
authors.forename: Sunil
authors.initials: S
authors.lastname: Richardson
authors.affiliation: Speech Language Pathologist, Department of Speech Language Pathology, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India.
authors.forename: Nikkie S
authors.initials: NS
authors.lastname: Seelan
authors.affiliation: Professor, Department of Orthodontics, Rajas Dental College and Hospital, Thirunelveli, Tamilnadu, India.
authors.forename: Dhivakar
authors.initials: D
authors.lastname: Selvaraj
authors.affiliation: Surgical Fellow, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India.
authors.forename: Rakshit V
authors.initials: RV
authors.lastname: Khandeparker
authors.affiliation: Speech Language Pathologist, Department of Speech Language Pathology, Dr Jeyashekaran Hospital, Nagercoil, Tamilnadu, India.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Gnanamony
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D013060:Speech; D013068:Speech Production Measurement; D016896:Treatment Outcome; D055815:Young Adult