Limited Chances of Speech Improvement After Late Cleft Palate Repair

Abstract

Late primary palatal repair is a common phenomenon, and many patients across the world will be operated on at a far later age than is suggested for normal speech development. Nevertheless, little is known about the speech outcomes after these procedures and conflicting results exist among the few studies performed. In this study, blinded preoperative and postoperative speech recordings from 31 patients operated on at Guwahati Comprehensive Cleft Care Center in Assam, India, older than 7 years were evaluated. Six non-Indian speech and language pathologists evaluated hypernasal resonance and articulation, and 4 local laymen evaluated the speech intelligibility/acceptability of the samples. In 25 of 31 cases, the evaluators could not detect any speech improvement in the postoperative recordings. A clear trend of postoperative improvement was only found in 6 of the 31 patients. Among these 6 patients, lesser clefts were overrepresented. Our findings together with previous studies suggest that late palate repairs have the potential to improve speech, but the probability for improvement and degree of improvement is low, especially in older adolescents and adults with complete clefts.

Sustainability of using the WHO surgical safety checklist: a mixed-methods longitudinal evaluation following a nationwide blended educational implementation strategy in Madagascar

“…The follow-up rate at 12–18 months in our longitudinal study was 37% (158/427 originally trained), compared with 47% (183/427) at 4 months 26. This is higher than other LMIC surgical evaluation studies that have reported follow-up rates of 17%–44%40–48 and slightly lower than response rates of 38%–70% for surveys and self-reporting studies in high-income countries 49 50. LMICs studies generally have lower follow-up rates than high-income countries due to challenges such as non-functioning telephone numbers and email addresses, inadequate record-keeping, transport costs and difficulties accessing rural locations.…”

“…Only two-thirds of the original hospital sites were visited and even though no hospital had received further checklist training in the interim, there may have been other factors in the interim that effected operating room procedures, practice and culture outside of our control or knowledge. Follow-up rate from the original training sample of 427 participants was only 37%, but this is comparable to surgical outcome studies in LMICs 40–48. We are unable to contextualise this further because we do not know what per cent of the total surgical staff this represents.…”

Desempenho de linguagem receptiva e expressiva em crianças com e sem Fissura Labiopalatina

“…The expressive skills are particularly impaired in children with CLP and are related to changes in articulation and resonance (8,15,19) . Studies have shown that changes in joint and hypernasality occur as a result of anatomical malformations, but they can also be observed after the child has been subjected to corrective surgical procedures (lip repair and / or palatoplasty) (13,14) .…”

“…The literature lacks attention on the subject (4) . Several studies along the past twenty years demonstrated that children with CLP show high variability of communication disorders (5) and many focus on speech related issues (5)(6)(7)(8) . Regarding language performance, there are differences described in the receptive and expressive skills among children with CLP when compared to children without CLP and with regular development, with increased predisposition to delayed acquisition of the first words, sentences production, language comprehension, memory and rationale (4,(9)(10)(11)(12) .…”

Optimizing Outcomes in Cleft Surgery

“…Clefts of the lip and palate can have devastating consequences. Children with cleft palate have difficulty with speech and feeding, which can lead to malnourishment and developmental delay [3,4]. Children with cleft lip face social stigma and often have lower levels of education and greater unemployment compared to their peers, despite having normal intellectual capacity [5][6][7].…”