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Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.ORCID iD: 0000-0002-8656-8064
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Speech-Language Pathology.ORCID iD: 0000-0002-6095-6130
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2022 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 59, no 8, p. 1030-1037Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective.

DESIGN: Retrospective, longitudinal study.

SETTING: A single multidisciplinary craniofacial team at a university hospital.

PATIENTS: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included.

MAIN OUTCOME MEASURES: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings.

RESULTS: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable.

CONCLUSIONS: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

Place, publisher, year, edition, pages
Sage , 2022. Vol. 59, no 8, p. 1030-1037
Keywords [en]
cleft type, cleft width, nasality, secondary surgery, speech production, velopharyngeal competence, velopharyngeal function
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-459538DOI: 10.1177/10556656211029537ISI: 000705465500001PubMedID: 34259078OAI: oai:DiVA.org:uu-459538DiVA, id: diva2:1614359
Available from: 2021-11-25 Created: 2021-11-25 Last updated: 2024-01-23Bibliographically approved
In thesis
1. Articulation and velopharyngeal function in patients with cleft lip and/or palate: Outcome predictors
Open this publication in new window or tab >>Articulation and velopharyngeal function in patients with cleft lip and/or palate: Outcome predictors
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cleft lip and/or palate is the most common congenital craniofacial malformation, requiring multidisciplinary treatment, including surgery and often speech therapy. Palatal surgery restores the anatomical barrier between the oral and nasal cavities as well as the palatal function needed for normal speech.

The present thesis aimed to investigate factors thought to impact surgical and speech outcomes. These factors include the timing of surgery, surgical technique, the surgeon's experience, cleft type, and cleft width.

Study I investigated the impact of cleft type and width on velopharyngeal function (VPF) and secondary surgery rates from ages three to 16. Cleft width was associated with increased surgery rates and signs of velopharyngeal insufficiency (VPI) at ages three and five. Contrary to some previous studies, surgery rates and speech outcomes were not associated with cleft type at any age.

Study II examined VPF and articulation development between ages five and ten in children adopted from China compared to Swedish-born children. Adoptees had palatoplasty later and had more severe articulation difficulties at both ages. The number of adoptees and non-adoptees with VPI was similar, but fewer adoptees had competent VPF.

Study III explored different types of intra-velar veloplasty and the impact of cleft width and surgeon experience on outcomes in 5-year-old children. Radical muscle dissection was not superior to intra-velar veloplasty reinforced by the palatopharyngeal muscle. Cleft width had a more significant impact on secondary surgery rates and VPF than did surgical technique—neither affected articulation proficiency.

Study IV examined the association between cleft type and width and surgical and speech outcomes, especially articulation, in 5-year-old children. Cleft width, not type, indicated articulation proficiency. The same errors occurred across all cleft types. Neither cleft type nor width was significantly associated with secondary surgery rates or VPF.

The present thesis highlights the importance of considering various factors when predicting secondary palatal surgery rates and speech outcomes. Cleft width significantly affects secondary surgery rates, VPF, and articulation proficiency, while cleft type and surgical technique do not. Adopted children are at higher risk of persistent articulation errors, which may partly be due to their later palatoplasty. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 62
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2009
Keywords
cleft lip and palate, cleft width, cleft type, surgical technique, articulation, velopharyngeal function, international adoption
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-519479 (URN)978-91-513-2012-0 (ISBN)
Public defence
2024-03-01, H:son Holmdahl-salen, Akademiska sjukhuset, ing. 100, 2 tr, Uppsala, 09:15 (English)
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Supervisors
Available from: 2024-02-09 Created: 2024-01-14 Last updated: 2024-02-09

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Okhiria, ÅsaJabbari, FatimaHakelius, MalinBlom Johansson, MonicaNowinski, Daniel

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