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Articulation and velopharyngeal function in patients with cleft lip and/or palate: Outcome predictors
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.ORCID iD: 0000-0002-8656-8064
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
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 [en]
cleft lip and palate, cleft width, cleft type, surgical technique, articulation, velopharyngeal function, international adoption
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-519479ISBN: 978-91-513-2012-0 (print)OAI: oai:DiVA.org:uu-519479DiVA, id: diva2:1827507
Public defence
2024-03-01, H:son Holmdahl-salen, Akademiska sjukhuset, ing. 100, 2 tr, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2024-02-09 Created: 2024-01-14 Last updated: 2024-02-09
List of papers
1. Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair.
Open this publication in new window or tab >>Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair.
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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
Keywords
cleft type, cleft width, nasality, secondary surgery, speech production, velopharyngeal competence, velopharyngeal function
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-459538 (URN)10.1177/10556656211029537 (DOI)000705465500001 ()34259078 (PubMedID)
Available from: 2021-11-25 Created: 2021-11-25 Last updated: 2024-01-23Bibliographically approved
2. Longitudinal data on speech outcomes in internationally adopted children compared with non‐adopted children with cleft lip and palate
Open this publication in new window or tab >>Longitudinal data on speech outcomes in internationally adopted children compared with non‐adopted children with cleft lip and palate
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2023 (English)In: International journal of language and communication disorders, ISSN 1368-2822, E-ISSN 1460-6984, Vol. 58, no 5, p. 1440-1453Article in journal (Refereed) Published
Abstract [en]

Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied.

Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non-adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups.

Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow-ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC-Sum) for single words and rated on a three-point scale (VPC-Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in-depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s-errors. Information on secondary palatal surgery and number of visits to an SLP was collected.

Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC-Sum, but not with VPC-Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s-errors at age 5 years, and CSCs and s-errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits.

Conclusions & and Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre-school years.

Place, publisher, year, edition, pages
Wiley, 2023
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-511350 (URN)10.1111/1460-6984.12869 (DOI)000949286400001 ()
Available from: 2023-09-12 Created: 2023-09-12 Last updated: 2024-01-23Bibliographically approved
3. The impact of surgical technique and cleft width on the rate of secondary surgery and velopharyngeal function
Open this publication in new window or tab >>The impact of surgical technique and cleft width on the rate of secondary surgery and velopharyngeal function
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(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:uu:diva-517722 (URN)
Available from: 2023-12-12 Created: 2023-12-12 Last updated: 2024-01-14
4. 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
Open this publication in new window or tab >>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
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(English)Manuscript (preprint) (Other academic)
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-517194 (URN)
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2024-01-14

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