Surgical, speech, and hearing outcomes at five years of age in internationally adopted children and Swedish-born children with cleft lip and/or palate

Abstract

Internationally adopted children (IAC) with a cleft lip and/or palate (CL/P) tend to arrive with un-operated palates at an age at which their Swedish-born peers have completed their primary palate surgery. Our aim of the present study was to analyze surgical, speech and hearing outcomes of IAC at age 5 and compare with those of a matched group of Swedish-born children. Fifty children with CL/P born in 1994-2005 participated in the study. Twenty-five IAC were matched according to age, sex and cleft type with 25 Swedish-born children. Audio recordings were perceptually analyzed by two experienced, blinded speech-language pathologists. Hearing and speech statuses were evaluated on the same day for all children. Surgical timing and complications as in fistulas and requirement for secondary velopharyngeal (VP) surgery, speech evaluation results, and present hearing status were analyzed for all children of age 5 years. Results showed that primary palatal surgery was delayed by a mean of 21 months in IAC. IAC had a higher prevalence of velopharyngeal impairment that was statistically significant, a higher fistula rate, and experienced more secondary surgery than Swedish-born peers. Hearing loss due to middle ear disease was slightly more common among IAC, whereas the rate of treatment with tympanostomy tubes was similar between the two groups. In conclusion, IAC with CL/P represent a challenge for CL/P teams because of the heterogeneous nature of the patient group and difficulties associated with delayed treatment, and the results show the importance of close follow-up over time. ARTICLE HISTORY

Predictive factors for secondary alveolar bone graft failure in patients with cleft alveolus

“…Our centre received a substantial number of adopted children, the majority arriving from China. They frequently received palatal surgery later than their native peers and clinically appeared to have a wider residual alveolar cleft and we aimed to study the eventual effect on SABG outcome in these children 40 . The following factors have been reported to impact SABG: gender, eruption stage of the tooth distal to the cleft, and orthodontic alignment to open up access to the cleft 5,12,13,18,20,21,25,26,30 ; however, these findings have been contradicted by other reports 7,12,13,16,18,19,27,37,41 .…”

“…They frequently received palatal surgery later than their native peers and clinically appeared to have a wider residual alveolar cleft and we aimed to study the eventual effect on SABG outcome in these children. 40 The following factors have been reported to impact SABG: gender, eruption stage of the tooth distal to the cleft, and orthodontic alignment to open up access to the cleft 5,12,13,18,20,21,25,26,30 ; however, these findings have been contradicted by other reports. 7,12,13,16,18,19,27,37,41 In this study, we included patients operated during two time periods, when the Gothenburg cleft centre faced a generation change where several less experienced surgeons performed SABG during the latter period.…”

The impact of COVID-19 on cleft services in Great Britain & Northern Ireland

“…A delay could result in a higher prevalence of velopharyngeal impairment, a higher fistula rate, and the need for more speech therapy and secondary surgery. [10] However, it is a controversial area of cleft care; some European units elect to delay cleft palate repair to reduce midfacial growth retardation [11]. However, there is evidence to suggest delay does result in long term articulation problems, secondary to learned compensatory behaviours in speech.…”

The Online Attention to Cleft Lip and Palate Research: An Altmetric Analysis

“…The earliest article was published in 1996 (Laumon et al, 1996) and the latest in 2020 (Schölin et al, 2020), but 63% of the articles were published within the last 5 years. The majority of the articles originated from the USA (46%), followed by Europe (16%) and the UK (15%).…”