Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age

Willadsen, Elisabeth; Bruinsma, Gerda; Alaluusua, Suvi; Pedersen, Nina-Helen; Nielsen, Joan Bogh; Hölttä, Elina; Hide, Øydis; Hayden, Christine; Havstam, Christina; Hammarström, Inger Lundeborg; Davies, Julie; Boers, Maria; Andersen, Helene Søgaard; Aukner, Ragnhild; Morris, David Jackson; Nielsen, Sandia; Semb, Gunvor; Lohmander, Anette; Persson, Christina

doi:10.1111/1460-6984.12830

Cited by 9 publications

(9 citation statements)

References 83 publications

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“…Aspects other than surgery and speech function might add to the understanding of what affects speech outcomes. 25 In conclusion, it is possible to affirm that these preliminary speech outcomes are similar to previous studies, regardless of surgical protocol.…”

Section: Vpc-rates Per Surgeon (N) Vpc Indicates Velopharyngeal Compe...supporting

confidence: 83%

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Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results

Antoneli

Fukushiro

Yamashita

et al. 2023

Journal of Craniofacial Surgery

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Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate. One hundred seventy nonsyndromic patients with unilateral cleft lip and palate were included in this report, 35% males and 65% females, submitted to the 2-stage palatoplasty protocol, composed by lip, nasal ala, and hard palate repair at 3 to 6 m (stage 1) and soft palate repair at 12 to 18 m (stage 2). The target age range for speech recording was 5 to 10 years, and the speech material included repetition of Brazilian Portuguese sentences. These samples were obtained over 5 years and assessed by 3 of 14 experienced speech pathologists. When discordant, the majority rate was adopted. Average velopharyngeal dysfunction (VPD) rates were 19,5%, varying according to the soft palate technique, with better results when the Sommerlad technique was performed (VPD=11%), followed by Braithwaite (VPD=15%) and then Von Langenbeck (VPD=25%). Passive errors were observed in 32% and active errors in 25%. Speech results reflect the outcomes of an interdisciplinary team’s work, where facial growth and nasolabial appearance must also be considered. Further analysis and a wider casuistic are recommended. Hence outcomes audit needs to be a permanent process, providing solid and updated evidence for optimal cleft care.

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Section: Vpc-rates Per Surgeon (N) Vpc Indicates Velopharyngeal Compe...supporting

confidence: 83%

“…Previous studies have examined speech outcomes and the relationship with surgical intervention in 5 year olds. Aspects other than surgery and speech function might add to the understanding of what affects speech outcomes 25 …”

Section: Discussionmentioning

confidence: 99%

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results

Antoneli

Fukushiro

Yamashita

et al. 2023

Journal of Craniofacial Surgery

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“…Several of the included studies were RCTs (28)(29)(30)(31)(34)(35)(36)(37)(38)(39) but understandably had to use unblinded operators, which inherently increases the risk of performance bias. This is a weakness that is difficult to avoid when conducting research on surgical techniques and outcomes, as it is impossible to use blinded surgeons and patients.…”

Section: Discussionmentioning

confidence: 99%

“…Speech outcomes were reported in four original studies. Two of these were RCTs within the Scandcleft trials (34,35), one was a subgroup analysis within the Scandcleft trials (36), and one was an independent RCT (37). In all the studies, speech was evaluated through perceptual speech assessment.…”

Section: Outcome O2: Speechmentioning

confidence: 99%

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

Cornefjord,

Arnebrant,

Guné

et al. 2023

JPHS

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The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon’s preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.

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“…No significant differences in velopharyngeal competency (evaluated with the composite variable VPC-sum) and hypernasality were found [10]. At 10 years of age, the results indicated that children treated with two-stage closure with hard palate closure at 36 months had lower PCC than children treated with simultaneous hard and soft palate closure at 12 months of age, whereas the proportion of children with primary VPC (without secondary surgery to improve function) was higher in the group with delayed hard palate closure [11]. A national survey from New Zealand included 56 children with cleft lip and palate at 10 years of age and found adequate velopharyngeal function in 66% and a need for further investigation or therapy in 25% [12].…”

Section: Introductionmentioning

confidence: 98%

Speech in 7- and 10-year-olds born with a unilateral cleft lip and palate: a continued prospective Swedish intercentre study

Havstam,

Brunnegård,

Hagberg

et al. 2023

JPHS

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The aim of this study was to report longitudinal speech results in consecutively selected children from each of the six cleft centres in Sweden and to compare the results between centres. The children were born with a non-syndromic unilateral cleft lip and palate, and results from the same cohort at 5 years of age have previously been reported. Background data on medical care in terms of surgery, speech therapy, and hearing between 5 and 10 years of age were collected. Speech recordings of 56 children at 7 years and 54 at 10 years of age were blindly and independently assessed by four speech-language pathologists experienced in cleft palate speech. This resulted in measures of percent consonant correct (PCC) and perceived velopharyngeal competence rated on a three-tier scale. No statistically significant differences were found between centres. PCC scores at 7 years of age ranged from 44-100% (median 97.5) and at 10 years of age from 86-100% (median 100). Competent or marginally incompetent velopharyngeal function was found in 95% of the 7-year-olds and 98% of the 10-year-olds. Speech results were slightly better than previous reports of speech in children born with a unilateral cleft lip and palate.

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Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age

Cited by 9 publications

References 83 publications

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

Speech in 7- and 10-year-olds born with a unilateral cleft lip and palate: a continued prospective Swedish intercentre study

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