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Associations between cleft type and width and the rate of secondary palatal surgery and articulation proficiency in 5-year-olds with cleft lip and/or palate
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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(English)Manuscript (preprint) (Other academic)
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:uu:diva-517194OAI: oai:DiVA.org:uu-517194DiVA, id: diva2:1817062
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2024-01-14
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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