ABSTRACT
OBJECTIVES: To describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit. SETTING AND SAMPLE POPULATION: A cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment. MATERIALS AND METHODS: Centre-based specialist speech and language therapists (SLT) took speech audio-video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested. RESULTS: For each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization. CONCLUSION: These results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry.
Subject(s)
Cleft Lip/complications , Cleft Palate/complications , Speech Disorders , Speech , Child, Preschool , Cleft Lip/classification , Cross-Sectional Studies , Female , Humans , Male , Reproducibility of Results , Treatment OutcomeABSTRACT
The purpose of this study was to compare outcomes and delivery of cleft care in Western Australia with the average standard of care in the United Kingdom (UK). This was achieved through a cross-sectional study involving children born with unilateral cleft lip and palate between April 1983 and March 1985 (12 year olds) or between April 1990 and March 1992 (5 year olds). A total of 38 children born with unilateral cleft lip and palate were under the care of the cleft team based at Perth's Princess Margaret Hospital. Dental arch relations, facial skeletal pattern, speech, hearing, success of alveolar bone grafting and dental health were measured. It was found that fewer Princess Margaret Hospital children in both age cohorts had revision surgery and speech therapy compared with the UK average. The facial skeletal pattern, speech, hearing and alveolar bone grafting outcomes from Princess Margaret Hospital were similar to the UK at age 12. Seventeen per cent of the Princess Margaret Hospital 12 year olds had a poor dental arch relationship compared with 39 per cent in the UK. In the 5 year olds, most outcomes in Princess Margaret Hospital patients appeared better than the UK with lower residual treatment needs. While it is difficult to draw firm conclusions because of the small numbers involved, this study indicates standards need to be set and determined for Australia.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Oral Surgical Procedures/standards , Bone Transplantation , Cephalometry , Child , Child, Preschool , Dental Care , Dental Occlusion , Female , Hearing , Humans , Male , Pilot Projects , Speech , Treatment Outcome , United Kingdom , Western AustraliaABSTRACT
OBJECTIVE: To review the history of cleft care in the United Kingdom and the rationale and methodology of a national study. DESIGN: Descriptive overview to introduce this series of papers. SETTING: Fifty National Health Service cleft teams. PATIENTS/PARTICIPANTS: Two age cohorts, 5-year-olds and 12-year-olds, with nonsyndromic complete unilateral cleft lip and palate and their parents. MAIN OUTCOME MEASURES: Facial development and appearance, quality of bone grafts, speech, oral health and patient/parent satisfaction. CONCLUSIONS: The case for a national assessment of cleft care is made. The methodology of the cross-sectional outcome study is described, together with a survey of training for recently appointed clinicians.
Subject(s)
Cleft Lip/therapy , Cleft Palate/therapy , Outcome Assessment, Health Care , Attitude of Health Personnel , Bone Transplantation/physiology , Cephalometry , Child , Child, Preschool , Cleft Lip/diagnostic imaging , Cleft Lip/physiopathology , Cleft Lip/surgery , Cleft Palate/diagnostic imaging , Cleft Palate/physiopathology , Cleft Palate/surgery , Cohort Studies , Cross-Sectional Studies , Dental Caries/classification , Esthetics , Female , Humans , Male , Maxillofacial Development/physiology , Models, Dental , Oral Fistula/classification , Patient Satisfaction , Photography , Quality Assurance, Health Care/methods , Radiography , Retrospective Studies , Speech/physiology , Treatment Outcome , United KingdomABSTRACT
OBJECTIVE: To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN: Prospective descriptive study on a cross-sectional sample of children. PATIENTS/PARTICIPANTS: Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. MAIN OUTCOMES: Ratings of intelligibility, nasality, "speech cleft type characteristics" and speech therapy intervention. CONCLUSIONS: Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.
Subject(s)
Cleft Lip/therapy , Cleft Palate/therapy , Speech/physiology , Child , Child, Preschool , Cleft Lip/physiopathology , Cleft Palate/physiopathology , Cohort Studies , Cross-Sectional Studies , Humans , Observer Variation , Outcome Assessment, Health Care , Phonetics , Prospective Studies , Reproducibility of Results , Speech Disorders/classification , Speech Disorders/therapy , Speech Intelligibility/physiology , Speech Therapy , Statistics, Nonparametric , Treatment Outcome , United Kingdom , Velopharyngeal Insufficiency/classification , Velopharyngeal Insufficiency/surgery , Videotape RecordingABSTRACT
OBJECTIVE: To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN: Cross-sectional outcome study. SETTING: Fifty National Health Service cleft centers. PARTICIPANTS: Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. RESULTS: Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. CONCLUSION: A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.
Subject(s)
Cleft Lip/therapy , Cleft Palate/therapy , Patient Satisfaction , Alveoloplasty , Attitude to Health , Bone Transplantation/physiology , Cephalometry , Child , Child, Preschool , Cleft Lip/diagnostic imaging , Cleft Palate/diagnostic imaging , Cohort Studies , Cross-Sectional Studies , Dental Arch/pathology , Dental Caries/classification , Esthetics , Humans , Malocclusion/classification , Maxillofacial Development/physiology , Observer Variation , Oral Fistula/classification , Outcome Assessment, Health Care , Parents , Radiography , Statistics as Topic , Treatment Outcome , United KingdomABSTRACT
OBJECTIVE: A critical appraisal of cleft care in the United Kingdom. DESIGN: Retrospective comparative study. SETTING: All National Health Service cleft centers in the United Kingdom. PATIENTS/PARTICIPANTS: Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. CONCLUSIONS: This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.
Subject(s)
Cleft Lip/therapy , Cleft Palate/therapy , Alveoloplasty , Attitude of Health Personnel , Bone Transplantation , Chi-Square Distribution , Child , Child, Preschool , Cleft Lip/surgery , Cleft Palate/surgery , Cohort Studies , Dental Arch/pathology , Esthetics , Europe , Health Status , Humans , Malocclusion/classification , Maxillofacial Development/physiology , Medical Audit , Oral Fistula/classification , Oral Health , Outcome Assessment, Health Care , Patient Satisfaction , Quality Assurance, Health Care , Retrospective Studies , Statistics, Nonparametric , Surgery, Oral/education , Surgery, Plastic/education , Treatment Outcome , United KingdomABSTRACT
A national study of care and outcomes in children born with a unilateral cleft lip and palate (UCLP) was performed over a 15-month period. Two cohorts of children ('5-year-olds' and '12-year-olds') were examined. There were 57 active cleft teams in the U.K. with 105 consultant orthodontists involved in the care of these children. Only 36 teams could provide basic data such as patients names. Of the patients, 47-51 per cent had neonatal appliances. The dental arch relationships were measured with the Goslon Index and a Five-Year-Old Index, 37-39 per cent of both age groups were either 'poor' or 'very poor'. Seventy per cent of the 12-year-old patients had a Skeletal III relation and 42 per cent of bone grafts were seriously deficient or failed. Dental treatment for active caries was needed by 40 per cent of 5-year-olds and 20 per cent of 12-year-olds. In addition, the training of recently appointed consultant orthodontists involved in the care of these children was scrutinized. As a whole, the results were disappointing with standards of care not significantly raised in the last decade. Recommendations have been made to the Department of Health and the implications for the orthodontic profession are explored. Overall, it seems that fewer orthodontists will need to be involved in a centralized care model for these children.
