title: A Comparison of the Need for Speech Therapy After 2 Palatal Repair Techniques.
abstract: BACKGROUND
  Reconstruction of the levator musculature during cleft palate repair has been suggested to be important in long-term speech outcomes. In this study, we compare the need for postoperative speech therapy between 2 intravelar veloplasty techniques.
  
  
  METHODS
  Chart review was performed for patients with nonsyndromic cleft palate who underwent either primary Kriens or overlapping intravelar veloplasty before 18 months of age. All subjects completed a follow-up visit at approximately 3 years of age. Data obtained included documentation of ongoing or recommended speech therapy at age 3 years and reasons for speech therapy, which were categorized as cleft-related and non-cleft-related by a speech-language pathologist.
  
  
  RESULTS
  One surgeon performed all Kriens procedures (n = 81), and the senior author performed all overlapping procedures (n = 25). Mean age at surgery (Kriens = 13.5 ± 1.4 months; overlapping = 13.1 ± 1.5 months; P = 0.188) and age at 3-year follow-up (Kriens = 3.0 ± 0.5 years; overlapping = 2.8 ± 0.5 years; P = 0.148) were equivalent in both groups. Cleft severity by Veau classification (P = 0.626), prepalatoplasty pure tone averages, (P = 0.237), pure tone averages at 3-year follow-up (P = 0.636), and incidence of prematurity (P = 0.190) were also similar between the 2 groups. At 3 years of age, significantly fewer overlapping intravelar veloplasty patients required cleft-related speech therapy (Kriens = 47%; overlapping = 20%; P = 0.015). The proportions of patients requiring non-cleft-related speech therapy were equivalent (P = 0.906).
  
  
  CONCLUSIONS
  At 3 years of age, patients who received overlapping intravelar veloplasty were significantly less likely to need cleft-related speech therapy compared with patients who received Kriens intravelar veloplasty. Cleft severity, hearing loss, and prematurity at birth did not appear to explain the difference found in need for speech therapy.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine; and †The Cleft Palate-Craniofacial Institute, St. Louis Children's Hospital, St. Louis, MO.
authors.forename: Debra W
authors.initials: DW
authors.lastname: Yen
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Nguyen
authors.forename: Gary B
authors.initials: GB
authors.lastname: Skolnick
authors.forename: Sybill D
authors.initials: SD
authors.lastname: Naidoo
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
authors.forename: Lynn Marty
authors.initials: LM
authors.lastname: Grames
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
mesh_terms: D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D013064:Speech Disorders / Q000209:etiology / Q000628:therapy*; D013070:Speech Therapy; D016896:Treatment Outcome