ABSTRACT
Multidisciplinary care for patients with clefts includes surgical correction of the
facial disfigurement and optimizing the quality of speech to improve the social integration
of the affected patient. This work summarizes the knowledge of communicational aspects
of cleft lip (CL) patients. Cleft-type speech characteristics can be described as
``passive'' obligatory errors resulting from the anatomical defect and ``active''
compensation efforts. Long-lasting phonological deficits in patients with clefts may
be due to the fact that their development is affected by abnormal learned neuromotor
patterns as a consequence of these two mechanisms. Surgery alone will not modify active
cleft-type characteristics whereas speech therapy should lead to an improvement. Passive
characteristics are usually assessed by speech therapy but surgery may facilitate
the progress. From the phoniatrician's point of view, rhinophonia in (secondary lip
and septo-) rhinoplasty (and surgery of the nasal sinuses) in CL patients has to be
assessed in no other way than in patients without a cleft. Pragmatic skills, that
is, using verbal speech in a social context, cognition, and the acquisition of emotional,
behavioral, and social interaction patterns may be affected in patients with isolated
CLs. As a consequence these individuals are at high risk to develop emotional disorders.
So speech developmental disorders in a narrow sense are of minor importance in individuals
with an isolated CL when comparing them with patients with CL and palate. Communication
disorders in these patients seem not to result from phonological defects but from
psychological problems that may influence the entire development of an affected child.
The literature shows that there is a need to collect more data on the issue of psychological
and social problems in patients with an isolated CL for clinical and scientific purposes.
KEYWORDS
Cleft lip - speech - cognition - social skill - emotional disorder
