Speech Outcome Analysis after Primary Cleft Palate Repair: Interim Siriraj Hospital Audit

Abstract

Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand.Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist.Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velopharyngeal mechanism 52.5%. Among the velopharyngeal incompetence group, articulation disorder was the most common disorder with median score of 3. Besides, the median scores for hypo/hyper-nasality, nasal emission, phonation, and facial grimace disorder were 1, 2, 0 and 0, respectively. There was no statistically significant association between velopharyngeal incompetence and cleft types, age at primary surgery, type of operation, the width of cleft palate and prevalence of postoperative oronasal fistula or otitis media effusion.Conclusion: Velopharyngeal incompetence has been commonly identified after cleft palate repair in our institute. The articulation disorder is the most common characteristic.

Exploration of the Utility of the Generic ICHOM Standard Set Measures in Evaluating the Speech of Patients with Cleft Lip/Palate

“…Several other studies have also reported score distributions with a similar skew to our sample and lower mean scores for PWSS "articulation" measurement. 33,34 Most studies using the PWSS report total scores (not scores from subcomponents). Total scores typically demonstrate a normal distribution among cleft patients, whereas the individual components of the scale may not demonstrate a normal distribution.…”

Thai CLEFT-Q: Phase 1—A Pilot Study of Translation and Cultural Adaptation in Thailand

“…1,2 Patients with CL/P typically require comprehensive multidisciplinary team care and long-term follow-up. 3 The principal aims of cleft care are to achieve the best quality of life in terms of function, esthetics, and psychosocial status. In the inceptive era of plastic and reconstructive surgery, "good esthetics" results from surgeons' perspectives might not match patients' perceptions.…”

Risk of Postpartum Hemorrhage in Hypertensive Disorders of Pregnancy: Stratified by Severity

“…1,2 In addition to mortality risk, the maternal complications of HDP include pulmonary edema, myocardial infarction, stroke, coagulopathy, and renal failure. 3 There is evidence [4][5][6][7][8] and biological plausibility (i.e., imbalance of angiogenic factors and coagulopathy, [9][10][11] prolonged induction of labor due to preterm pregnancies, and use of magnesium sulfate [MgSO 4 ]-a medication associated with smooth muscle relaxation and potentially uterine atony 12,13 ) suggesting that individuals with HDP are more likely to have postpartum hemorrhage (PPH), defined as blood loss of 1,000 mL or more within 24 hours of delivery. 14 However, the current American College of Obstetricians and Gynecologists (ACOG) practice bulletin on gestational hypertension (gHTN) and preeclampsia does not acknowledge this assoication.…”

“…First, the majority of published reports do not specify whether the association of HDP with PPH involves all cases of HDP, including chronic hypertension (cHTN), gHTN, and preeclampsia without severe features or if it is limited to only preeclampsia with severe features. 5,[17][18][19][20][21][22] Second, there are inconsistencies in the definitions of both HDP and PPH, with many publications not following contemporary ACOG guidelines. 5,11,21,23 Third, the majority of reports are from abroad, and findings may not be applicable to the United States.…”

“…5,[17][18][19][20][21][22] Second, there are inconsistencies in the definitions of both HDP and PPH, with many publications not following contemporary ACOG guidelines. 5,11,21,23 Third, the majority of reports are from abroad, and findings may not be applicable to the United States. [4][5][6]8,11,16,21,23,24 Due to these shortcomings, we undertook this retrospective analysis.…”