ABSTRACT
The aim of this study was to compare the speech in subjects with cleft lip and palate, in whom three methods of the hard palate closure were used. One hundred and thirty-seven children (96 boys, 41 girls; mean age = 12 years, SD = 1·2) with complete unilateral cleft lip and palate (CUCLP) operated by a single surgeon with a one-stage method were evaluated. The management of the cleft lip and soft palate was comparable in all subjects; for hard palate repair, three different methods were used: bilateral von Langenbeck closure (b-vL group, n = 39), unilateral von Langenbeck closure (u-vL group, n = 56) and vomerplasty (v-p group, n = 42). Speech was assessed: (i) perceptually for the presence of a) hypernasality, b) compensatory articulations (CAs), c) audible nasal air emissions (ANE) and d) speech intelligibility; (ii) for the presence of compensatory facial grimacing, (iii) with clinical intra-oral evaluation and (iv) with videonasendoscopy. A total rate of hypernasality requiring pharyngoplasty was 5·1%; total incidence post-oral compensatory articulations (CAs) was 2·2%. The overall speech intelligibility was good in 84·7% of cases. Oronasal fistulas (ONFs) occurred in 15·7% b-vL subjects, 7·1% u-vL subjects and 50% v-p subjects (P < 0·001). No statistically significant intergroup differences for hypernasality, CAs and intelligibility were found (P > 0·1). In conclusion, the speech after early one-stage repair of CUCLP was satisfactory. The method of hard palate repair affected the incidence of ONFs, which, however, caused relatively mild and inconsistent speech errors.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Plastic Surgery Procedures/methods , Speech Intelligibility/physiology , Adolescent , Child , Female , Follow-Up Studies , Humans , Infant , Male , Recovery of Function/physiology , Treatment OutcomeABSTRACT
During the period between 1993 and 1998 thirty-one children with symptoms of Pierre-Robin sequence were treated. Since gastroesophageal reflux (GER) is known to occur in patients with Pierre - Robin sequence, each child before surgery was checked for GER. In 28 cases GER was confirmed. We obtained rapid clinical improvement and possibility of early discharge from hospital after surgical treatment (palatoplasty, SRFM - subperiosteal release of the floor of the mouth, repair of the palato-pharyngeal ring). Follow up investigations few months after surgery showed no clinical symptoms of GER. The authors find evidence of " palatal mechanism" of GER in Pierre-Robin sequence and in their opinion early closure of the impaired palto-pharyngeal ring and elimination of mechanism causing posterior rotation of the tonque can reduce indications for such surgical procedures as glossopexy, gastrostomy, tracheostomy and Nissen fundoplication.
Subject(s)
Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/surgery , Pierre Robin Syndrome/complications , Child , Child, Preschool , Female , Gastroesophageal Reflux/etiology , Humans , Infant , Male , Palate/surgery , Pharynx/surgeryABSTRACT
The early restoration of facial and palatal morphology in patients with cleft of lip and/or palate provides the anatomical base for good speech outcome. The author gives the up todate overview of the main problems concerning cleft speech, such as velopalatal insufficiency and typical articulation errors. The article describes the modern methods for the evaluation of VPI and current trends in treatment modalities for VPI.
