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Open Access
CC BY 4.0 · Arch Plast Surg 2024; 51(04): 378-385
DOI: 10.1055/s-0044-1787002
Pediatric/Craniomaxillofacial/Head & Neck
Original Article

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate

Mona Haj 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
S.N. Hakkesteegt 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
H.G. Poldermans 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
H.H.W. de Gier 
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
S.L. Versnel 
3   Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
,
E.B. Wolvius 
1   Department of Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
› Author Affiliations
Funding None.
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Abstract

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG).

Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively.

Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% (p < 0.001). Grimacing decreased in 27% (p = 0.015). Articulation disorders remained present in 85% (p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively (p < 0.001).

Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Keywords

cleft lip with or without cleft palate - cleft palate - speech - hard palate closure - alveolar bone grafting

Authors' Contributions

All Authors contributed to; (1) substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Ethical Approval

Since subjects are not being subjected to any handling, nor are there rules of human behavior being imposed, Institutional Review Board Approval was waived by the ethical committee of the hospital (MEC-2017-400).


Patient Consent

Not Applicable.




Publication History

Received: 03 August 2023

Accepted: 09 April 2024

Article published online:
14 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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