To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol.
Design:
A retrospective, descriptive, cross-sectional consecutive series.
Setting:
A regional twin site center; a district general hospital and tertiary children’s hospital.
Participants:
Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate.
Intervention:
Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad.
Outcome Measures:
Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented.
Results:
A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI.
Conclusions:
Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
AhlRHarding-BellA. Comparing methodologies in a series of speech outcome studies. Cleft Palate-Craniofac J. 2017;55(1):35–44.
2.
AltmanDG. Practical Statistics for Medical Research. CRC Press; 1990.
3.
AndradesPEspinosa-los-MonterosADShellIV DHToddETJessicaSFSudeepTXPeterDRJohnHGIII. The importance of radical intravelar veloplasty during two-flap palatoplasty. Plastic Reconst Surg. 2008;122(4):1121–1130.
4.
BarronWM. Failed appointments. Who misses them, why they are missed, and what can be done. Primary Care. 1980;7(4):563–574.
5.
BearnDMildinhallSMurphyTMurrayJSellDShawWCWilliamsACSandyJR. Cleft lip and palate care in the United Kingdom—the clinical standards advisory group (CSAG) study. Part 4: outcome comparisons, training, and conclusions. Cleft Palate-Craniofac J. 2001;38(1):38–43.
6.
BeckerMHanssonE. Low rate of fistula formation after Sommerlad palatoplasty with or without lateral incisions: an analysis of risk factors for formation of fistulas after palatoplasty. J Plast Reconstr Aesthet Surg. 2013;66(5):697–703.
BrittonLAlberyLBowdenMHarding-BellAPhippenGSellD. A cross-sectional cohort study of speech in five-year-olds with cleft palate +/- lip to support development of national audit standards: benchmarking speech standards in the United Kingdom. Cleft Palate-Craniofac J. 2014;51(4):431–451.
9.
BrothersDBDalstonRWPetersonHDLawrenceWT. Comparison of the Furlow double-opposing Z-palatoplasty with the Wardill-Kilner procedure for isolated clefts of the soft palate. Plastic Reconst Surg. 1995;95(6):969–977.
10.
BruneelLBettensKDe BodtMRocheNBonteKVan LierdeK. Speech outcomes following Sommerlad primary palatoplasty: results of the Ghent University Hospital. J Commu Disord. 2018;72(1):111–121.
11.
BrunnegardKLohmanderA. A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability. Cleft Palate-Craniofac J. 2007;44(1):33–44.
12.
CairnsGWilsonJde LangeJMehendaleFV. Sommerlad palate repair—burden of care and predictive factors for speech outcomes at age 5 years—a study of the first consecutive cases of a single surgeon. Paper presented at ESPRAS Congress; Edinburgh, United Kingdom: 2014.
13.
ChapmanKLBaylisATrost-CardamoneJKelly NettCAngelaDCindyDAnnaTKristinaWAnne HardingBTrionaS, et al.The Americleft Speech Project: a training and reliability study. Cleft Palate-Craniofac J. 2016;53(1):93–108.
14.
ChapmanKLHardin-JonesMAGoldsteinJAHalterKAHavlikRJSchulteJ. Timing of palatal surgery and speech outcome. Cleft Palate-Craniofac J. 2008;45(3):297–308.
15.
ChapmanKLHardin-JonesMAHalterKA. Vocal development of 9 month old babies with cleft palate. J Speech Lang Hear Res. 2001;44(6):1268–1284.
16.
ChapmanKLWilladsenE. The development of speech in children with cleft palate. In: HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and Intervention. Wiley-Blackwell; 2011:55–85.
17.
ChoaRMSlatorRJeremyARobinsonSFranklinDRobertsAWinterRExtenceHCollardMClarkV. Identifying the effect of cleft type, deprivation and ethnicity on speech and dental outcomes in UK cleft patients: a multi-centred study. J Plastic, Reconst Aesthetic Surg. 2014;67(12):1637–1643.
18.
Cleft Registry and Audit Network (CRANE). Publications. Accessed October 28, 2019.www.crane-database.org.uk
19.
Clinical Standards Advisory Group Cleft Lip and/or Palate. HMSO, ISBN 0-11-322103-7. London; 1998.
20.
D’AndréaGMaschiCSavoldelliCCaciHBailleuxS. Otologic outcomes with two different surgical protocols in patients with a cleft palate: a retrospective study. Cleft Palate-Craniofac J. 2018;55(9):1289–1295.
21.
DavariHAZahediMDerakhshandehF. The prevalence of hypernasality after primary cleft palate surgery in children. J Isfahan Med School. 2012;30(175):(page numbers in Arabic).
22.
DerakhshandehFPoorjavadM. The study of speech disorders and middle ear diseases following primary palatoplasty in children with cleft palate. J Isfahan Med School. 2011;29:222–229.
23.
DissauxCGrollemundBBodinF, et al.Evaluation of 5-year-old children with complete cleft lip and palate: multicenter study. Part 2: functional results. J Craniomaxillofac Surg. 2016;44(2):94–103.
24.
DorfDSCurtinJW. Early cleft palate repair and speech outcome. Plast Reconstr Surg. 1982;70(1):74–81.
25.
DoucetJCHerlinCCaptierGBaylonHVerdeilMBigorreM. Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate. British J Oral Maxillofac Surg. 2013;51(8):845–850.
26.
EvansDRenfrewC. The timing of primary cleft palate repair. Scand J Plast Reconstr Surg. 1974;8(1-2):153–155.
27.
FeragenKBStockNM. When there is more than a cleft: psychological adjustment when a cleft is associated with an additional condition. Cleft Palate-Craniofac J. 2014;51(1):5–14.
FitzsimonsKJCopleyLPVan Der MeulenJHPanagamuwaCDeaconSA. Grommet surgery in children with orofacial clefts in England. Cleft Palate-Craniofac J. 2017;54(1):80–89.
GaniBKinshuckASharmaR. A review of hearing loss in cleft palate patients. Int J Otolaryngol. 2012;2012:6. Article ID 548698.
32.
GohBSTangCLHashimNDAnnamalayTAbd RahmanFN. Hearing status and behavioural patterns among school aged children with cleft lip and/or palate. Int J Pediatr Otorhinol. 2019;118(2):1–5.
GrobbelaarAHudsonDFernandesDLentinR. Speech results after repair of the cleft soft palate. Plast Reconstr Surg. 1995;95(7):1150–1154.
35.
GustafssonCHeliovaaraALeikolaJRautioJ. Incidence of speech-correcting surgery in children with isolated cleft palate. Cleft Palate-Craniofac J. 2018;55(8):1115–1121.
36.
Hardin-JonesMAJonesDL. Speech production of preschoolers with cleft palate. Cleft Palate-Craniofac J. 2005;42(1):7–13.
37.
HardwickeJRichardsHCafferkyLUnderwoodITer HorstBSlatorR. Outcomes of cleft palate repair in patients with Pierre Robin sequence: a matched case-control study. Plast Reconstr Surg. 2016;137(3):927–935.
38.
HassanMEAskarS. Does palatal muscle reconstruction affect the functional outcome of cleft palate surgery?Plast Reconstr Surg. 2007;119(6):1859–1865.
39.
HayNPatelBHariaPSommerladB.Maxillary growth in cleft lip and palate patients, with and without vomerine flap closure of the hard palate at the time of lip repair: a retrospective analysis of prospectively collected nonrandomized data, with 10-year cephalometric outcomes. Cleft Palate-Craniofac J. 2018;55(9):1205–1210.
40.
HensGSellDPinkstoneMBirchMJHayNSommerladBCKangesuL. Palate lengthening by buccinator myomucosal flaps for velopharyngeal insufficiency. Cleft Palate-Craniofac J. 2013;50(5):84–91.
41.
HenningsonGWilladsenE. Cross linguistic perspectives on speech assessment in cleft palate. In: HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and Intervention. Wiley-Blackwell; 2011:167–179.
42.
HosseinabadHHDerakhshandehFMostaajeranFAbdaliHDavariHAHassanzadehAKummerAW. Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: a retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009. Int J Pediat Otorhinol. 2015;79:1722–1726.
43.
HuttersBHenningssonG. Speech outcome following treatment in cross-linguistic cleft palate studies: methodological implications. Cleft Palate-Craniofac J. 2004;41(5):544–549.
44.
HynesW. Pharyngoplasty by muscle transplantation. British J Plast Surg. 1950:128–135.
45.
HynesW. The results of pharyngoplasty by muscle transplantation in “failed cleft palate” cases, with special reference to the influence of the pharynx on voice production. British J Plast Surg. 1993;46(5):430–439.
46.
JergerJ. Clinical experience with impedance audiometry. Arch Otolaryngol. 1970;92(4):311–324.
47.
JohnASellDSweeneyTHarding-BellAWilliamsA.The cleft audit protocol for speech—augmented: a validated and reliable measure for auditing cleft speech. Cleft Palate-Craniofacial J. 2006;43(3):272–288.
48.
JolleysA. A review of the results of operations on cleft palates with reference to maxillary growth and speech function. British J Plast Surg. 1954;7(3):229–241.
49.
KaplanEN. Cleft palate repair at three months?Ann Plastic Surg. 1981;7(10):179–190.
50.
KirschnerREWangPJawadAFDuranMCohenMSolotCRandallPLaRossaD. Cleft-palate repair by modified Furlow double-opposing Z-plasty: the children’s hospital of Philadelphia experience. Plast Reconstr Surg. 1999;104(7):1998–2010; discussion 2011-1994.
51.
KitchinSGramesLNaidooSDSkolnickGSchoenbornASnyder-WarwickAPatelK. Surgical, speech, and audiologic outcomes in patients with orofacial cleft and Van der Woude syndrome. J Craniofac Surg. 2019;30(5):1484–1487.
52.
KlintöKFalkEWilhelmssonSSchönmeyrBBeckerM. Speech in 5-year-olds with cleft palate with or without cleft lip treated with primary palatal surgery with muscle reconstruction according to Sommerlad. Cleft Palate-Craniofacial J. 2018;55(10):1399–1408.
53.
KuehnDPEttemaSLGoldwasserMSBarkmeierJC. Magnetic resonance imaging of the levator veli palatini muscle before and after primary palatoplasty. Cleft Palate-Craniofacial J. 2004;41(6):584–592.
54.
LewinMHellerJKojakD. Speech results after Millard island flap repair in cleft palate and other velopharyngeal insufficiencies. Cleft Palate J. 1975;12(3):263–269.
55.
LidénG. The scope and application of current audiometric tests. J Laryngol Otol. 1969;83(6):507–520.
56.
LindsayWWitzelM.Cleft palate repair: Von Langenbeck technique. In: BardachJMorrisHL, eds. Multidisciplinary Management of Cleft Lip and Palate. WB Saunders Company; 1990:303.
57.
Lohmander-AgerskovADotevalHLithASoderpalmE. Speech and velopharyngeal function in children with an open residual cleft in the hard palate, and the influence of temporary covering. Cleft Palate-Craniofac J. 1996;33:324–332.
58.
LohmanderAPerssonC. A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair. Cleft Palate-Craniofac J. 2008; 45(1): 32–41.
59.
LohmanderAWilladsenEPerssonCHenningssonGBowdenMHuttersB. Methodology for speech assessment in the Scandcleft project—an international randomized clinical trial on palatal surgery: experiences from a pilot study. Cleft Palate-Craniofac J. 2009;46(4):347–362.
60.
LohmanderA. Surgical intervention and speech outcomes in cleft lip and palate. In: HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and Intervention. Wiley-Blackwell; 2011:55–85.
61.
LohmanderAOlssonMFlynnT. Early consonant production in Swedish infants with and without unilateral cleft lip and palate and two-stage palatal repair. Cleft Palate-Craniofac J. 2011;48(3):271–285.
62.
LohmanderAHagbergEPerssonCWilladsenELundeborgIDaviesJHavstamCBoersMKisling-MollerMAlaluusuaS, et al.Validity of auditory perceptual assessment of velopharyngeal function and dysfunction—the VPC-sum and the VPC-rate. Clin Linguist Phonet. 2017;31(7-9):589–597.
63.
LohmanderAPerssonCWilladsenELundeborgIAlaluusuaSAuknerRBauABoersMBowdenMDaviesJ, et al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds-velopharyngeal competency and hypernasality. J Plastic Surg Hand Surg. 2017;51(1):27–37.
64.
LuYShiBZhengQHuQWangZ. Incidence of palatal fistula after palatoplasty with levator veli palatini retropositioning according to Sommerlad. British J Oral Maxillofac Surg. 2010;48(8):637–640.
65.
LuytenABettensKD’HaeseleerEDe LeySHodgesAGaliwangoGBonteKVermeerschHVan LierdeK. Impact of early synchronous lip and palatal repair on speech. Folia Phoniatrica et Logopaedica. 2013;65(6):303–311.
66.
LuytenABettensKD’HaeseleerEDe LeySHodgesAGaliwangoGBonteKVermeerschHVan LierdeK. The impact of palatal repair before and after 6 months of age on speech characteristics. Int J Pediat Otorhinol. 2014;78(5):787–798.
67.
MaggiulliFHayNMarsMWorrellEGreenJSommerladB. Early effect of vomerine flap closure of the hard palate at the time of lip repair on the alveolar gap and other maxillary dimensions. Cleft Palate-Craniofac J. 2014;51(1):43–48.
68.
MahoneyM-HSwanMCFisherDM. Prospective analysis of presurgical risk factors for outcomes in primary palatoplasty. Plastic Reconstr Surg. 2013;132(1):165–171.
69.
MaparDKhanlarFSadeghiSHosseinAMehrdadMHeydar AliDFatemehD. The incidence of velopharyngeal insufficiency and oronasal fistula after primary palatal surgery with Sommerlad intravelar veloplasty: a retrospective study in Isfahan Cleft Care Team. Int J Pediat Otorhinol. 2019;120:6–10.
70.
MarrinanELaBrieRAMullikenJB. Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type. Cleft Palate-Craniofac J. 1998; 35(2):95–100.
71.
MirotznikJGinzlerEZagonGBaptisteA. Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition. J Comm Health. 1998;23(3):195–210.
72.
MoarKKSweetCBealeV. Fistula rate after primary palatal repair with intravelarveloplasty: a retrospective three-year audit of six units (NorCleft) in the UK. British J Oral Maxillofac Surg. 2016;54(6):634–637.
73.
MoriceARenaultFSoureVChapuisCTrichet ZbideCKadlubNGiudiceAVazquezMPPicardA. Predictors of speech outcomes in children with Pierre Robin sequence. J Craniomaxillofac Surg. 2018;46(3):479–484.
74.
MungallIJ. Trend towards centralisation of hospital services, and its effect on access to care for rural and remote communities in the UK. Rural Remote Health. 2005;5(2):390.
75.
NessAWillsAWaylenAAl GhatamRJonesTEMPrestonRIrelandAJPerssonMSmallridgeJHallAJ, et al.Centralization of cleft care in the UK. Part 6: a tale of two studies. Orthodont Craniofac Res. 2015;18(4):56–62.
76.
NopoulosPRichmanLAndreasenNMurrayJCSchutteB. Cognitive dysfunction in adults with Van der Woude syndrome. Gene Med. 2007;9(4):213.
77.
NybergJNeoviusELohmanderA. Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate. J Plast Surg Hand Surg. 2018;52(1):20–29.
78.
NybergJPetersonPLohmanderA. Speech outcomes at age 5 and 10 years in unilateral cleft lip and palate after one-stage palatal repair with minimal incision technique—a longitudinal perspective. Int J Paediat Otorhino. 2014;78(1):1662–1670.
79.
NybergJWestbergLRNeoviusELarsonOHenningssonG. Speech results after one-stage palatoplasty with or without muscle reconstruction for isolated cleft palate. Cleft Palate-Craniofac J. 2010;47(1):92–103.
80.
O’GaraMMLogemannJA. Phonetic analyses of the speech development of babies with cleft palate. Cleft Palate J. 1988;25(2):122–134.
81.
O’GaraMMLogemannJARademakerAW. Phonetic features by babies with unilateral cleft lip and palate. Cleft Palate-Craniofac J. 1994;31(6):446–451.
82.
OllerDK. The Emergence of the Speech Capacity. Lawrence Erlbaum Associates; 2000.
83.
PatelKBSullivanSRMurthyASMarrinanEMullikenJB. Speech outcome after palatal repair in nonsyndromic versus syndromic Robin sequence. Plast Reconstr Surg. 2012:577–584.
84.
PeetE. The oxford technique of cleft palate repair. Plastic Recons Surg Trans Bull. 1961;28(1):282–294.
85.
PereiraVJSellDTuomainenJ. Effect of maxillary osteotomy on speech in cleft lip and palate: perceptual outcomes of velopharyngeal function. Int J Lang Comm Disord. 2013;48(6):640–650.
86.
PereiraV. The VPC-SUM CAPS-A: notes from an osteotomy study. Invited Presentation at The Cleft Lip and Palate Speech and Language Therapy Clinical Excellence Network Meeting; 2019; London, United Kingdom.
87.
PerssonCElanderALohmander-AgerskovASöderpalmE. Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations. Cleft Palate-Craniofacial J. 2002;39(4):397–408.
88.
PerssonCLohmanderAElanderA. Speech in children with an isolated cleft palate: a longitudinal perspective. Cleft Palate-Craniofacial J. 2006;43(3):295–309.
89.
PerssonCPedersenNHHaydenCBowdenMAuknerRVindenesHAAbyholmFWithbyDWilladsenELohmanderA. Scand Cleft Project Trial 3: comparison of speech outcomes in relation to sequence in 2-stage palatal repair procedures in 5-year-olds with unilateral cleft lip and palate. Cleft Palate-Craniofacial J. 2020;57(3):352–363.
90.
Peterson-FalzoneSJ.Optimal age for palatoplasty to facilitate normal speech development: what is the evidence? In: BerkowitzS, ed. Cleft Lip and Palate. Springer; 2006:691–703.
91.
PosnettJ. Is bigger better? Concentration in the provision of secondary care. British Med J. 1999;319(7216):1063–1065.
92.
PurdieSCJae-HyunKHarding-BellA. Hearing loss and the impact on speech in children with cleft palate. In: Harding-BellA, ed. Case Studies in Cleft Palate Speech Data Analysis and Principled Intervention. J&R Press; 2019:225–272.
93.
RandallPLaRossaDDFakhraeeSMCohenMA. Cleft palate closure at 3-7 months of age: a preliminary report. Plastic Recons Surg. 1983;71(3):624–628.
94.
RautioJAndersenMBolundSHukkiJVindenesHDavenportPArctanderKLarsonOBerggrenAAbyholmF, et al.Scand cleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results. J Plastic Surg Hand Surg. 2017;51(1):14–20.
95.
ReardonJBBrustowiczKAMarrinanEMMullikenJBPadwaBL. Anatomic severity, midfacial growth, and speech outcomes in Van der Woude/popliteal pterygium syndromes compared to nonsyndromic cleft lip/palate. Cleft Palate-Craniofac J. 2015;52(6):676–681.
96.
ReddyRRReddySGVaidhyanathanABergéSJKuijpers-JagtmanAM. Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review. J Cranio-Maxillofac Surg. 2017;45(6):995–1003.
97.
RintalaAEHaapanenML. The correlation between training and skill of the surgeon and reoperation rate for persistent cleft palate speech. British J Oral Maxillofac Surg. 1995;33(5):295–298.
98.
RobertsonAGMcKeownDJBello-RojasGYeon-JeenCAmyRBarbaraJBMarkBIanTJ. Use of buccal myomucosal flap in secondary cleft palate repair. Plastic Reconst Surg. 2008;122(3):910–917.
99.
RohrichRJRowsellARJohnsDFDruryMAGriegGWatsonDJGodfreyAMPooleMD. Timing of hard palatal closure: a critical long-term analysis. Plastic Reconst Surg. 1996;98(2):236–246.
Rossell-PerryPCotrinal-RabanalOCaceres-NanoE. One-flap palatoplasty: a cohort study to evaluate a technique for unilateral cleft palate repair. Plastic Reconst Surg Global Open. 2015;3(4):e373.
102.
SchererNJD’AntonioLLMcGaheyH. Early intervention for speech impairment in children with cleft palate. Cleft Palate-Craniofacial J. 2008;45(1):18–31.
103.
SellD. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord. 2005;40(2):103–121.
104.
SellDGrunwellPMildinhallSMurphyTCornishTABearnDShawWCMurrayJJWilliamsACSandyJR. Cleft lip and palate care in the United Kingdom—the clinical standards advisory group (CSAG) study. Part 3: speech outcomes. Cleft Palate-Craniofac J. 2001;38(1):30–37.
105.
SellDHardingAGrunwellP. GOS. SP. ASS.’98: an assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised). Int J Lang Commun Disord. 1999;34(1):17–33.
106.
SellDJohnAHarding BellASweeneyTHegartyFFreemanJ. Cleft Audit Protocol for Speech (CAPS-A): a comprehensive training package for speech analysis. Int J Lang Commun Disord. 2009;44(4):529–548.
107.
SellDMildinhallSAlberyLWillsAKSandyJRNessAR. The cleft care UK study. Part 4: perceptual speech outcomes. Orthodon Craniofac Res. 2015;18(suppl 2):36–46.
108.
SellDSouthbyLWrenYWillsAKHallAMahmoudOWaylenASandyJRNessAR. Centre-level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5-year-old children with non-syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 4. Orthodon Craniofac Res. 2017;20(6):27–39.
109.
SembGEnemarkHFriedeHPaulinGLiljaJRautioJAndersenMAbyholmFLohmanderAShawW, et al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management. J Plastic Surg Hand Surg. 2017;51(1):2–13.
110.
ShawWSembG. The Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 11. What next?J Plastic Surg Hand Surg. 2017;51(1):88–93.
111.
ShawWSembGLohmanderAPerssonCWilladsenEClayton-SmithJTrindadeIKMunroKJGambleCHarmanNH, et al.Timing of primary surgery for cleft palate (TOPS): protocol for a randomised trial of palate surgery at 6 months versus 12 months of age. British Med J Open. 2019;9:e029780.
112.
SheahanPBlayneyAW. Cleft palate and otitis media with effusion: a review. Revue de Laryngologie Otologie Rhinologie. 2003;124(3):171–177.
113.
ShribergLDMcSweenyJLAndersonBEThomasFCMichaelRCJordanRGKatherinaKHChristopherAMHeatherLRDavidLW. Transitioning from analog to digital audio recording in childhood speech sound disorders. Clin Lingui Phone. 2005;19(4):335–359.
114.
SimJWrightCC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Therap. 2005;85(3):257–268.
115.
SlatorRPerisanidouLLWaylenASandyJNessAWillsAK. Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: the Cleft Care UK study. Orthod Craniofac Res. 2020;23(2):166–173. doi:10.1111/ocr.12355.
116.
SmillieIRobertsonSYuleAWynneDMRussellCJH. Complications of ventilation tube insertion in children with and without cleft palate. A nested case-control comparison. Otolaryngol Head Neck Surg. 2014;140(10):940–943.
117.
SmythAGWuJ. Cleft palate outcomes and prognostic impact of palatal fistula on subsequent velopharyngeal function—a retrospective cohort study. Cleft Palate-Craniofac J. 2019;56(8):1008–1012.
118.
SommerladBC. A technique for cleft palate repair. Plast Reconstr Surg. 2003;112(6):1542–1548.
119.
SommerladBC. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003;112(6):1540–1541.
120.
SommerladBC. Surgery of the cleft palate: repair using the operating microscope with radical muscle retropositioning: the GosstA approach. B-ENT. 2006;2(suppl 4):32–34.
121.
SommerladB. Challenges for cleft care in the developing and the developed world. In: MarsMSellDHabelA, eds. Management of Cleft Lip and Palate in the Developing World. John Wiley & Sons Ltd; 2008:31–36.
122.
SommerladB. Cleft palate repair with minimal hard palate dissection and radical muscle reconstruction. In: Comprehensive Cleft Care. 2nd ed. CRC Press; 2016;2:962–975.
123.
SommerladBBoormanJ. Muscle reconstruction in cleft and submucous cleft palates. British J Plastic Surg. 1989;42(3):360.
124.
SommerladBCHenleyMBirchMHarlandKMoiemenNBoormanJ. Cleft palate re-repair—a clinical and radiographic study of 32 consecutive cases. British J Plastic Surg. 1994;47(6):406–410.
125.
SommerladBCMehendaleFVBirchMJSellDHatteeCHarlandK. Palate re-repair revisited. Cleft Palate Craniofac J. 2002;39(3):295–307.
126.
Stoel-GammonC. Prelinguistic vocal development: measurement and predictions. In: FergusonCAMennLStoel-GammonC, eds. Phonological Development: Models, Research, Implications. York Press; 1992:439–456.
127.
StranskyCBastaMSolotCCohenMLowDWLarossaDJacksonO. Do patients with Pierre Robin sequence have worse outcomes after cleft palate surgery?Ann Plastic Surg. 2013;71(2):292–296.
128.
SullivanSRMarrinanEMLa BrieRARogersGFMullikenJB. Palatoplasty outcomes in nonsyndromic patients with cleft palate: a 29-year assessment of one surgeon’s experience. J Craniofac Surg. 2009;20(3):612–616.
129.
SzczepuraA. Access to health care for ethnic minority populations. Postgrad Med J. 2005;81(1):141–147.
130.
VieraAJGarrettJM. Understanding interobserver agreement: the kappa statistic. Family Med. 2005;37(5):360–363.
131.
VihmanMM. Early syllables and the construction of phonology. In: FergusonCAMennLStoel-GammonC, eds. Phonological Development: Models, research, Implications. York Press; 1992:393–422.
132.
WallaceAF. A history of the repair of cleft lip and palate in Britain before World War II. Ann Plastic Surg. 1987;19(3):266–275.
WilladsenEAlbrechtsenH. Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate. Cleft Palate Craniofac J. 2006;43(2):189–200.
135.
WilladsenELohmanderAPerssonCLundbergIAlaluusuaSAuknerRBauABoersMBowdenMDaviesJ, et al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds-consonant proficiency and errors. J Plast Surg Hand Surg. 2017;51(1):38–51.
136.
WilliamsACSandyJThomasSSellDSterneJA. Influence of surgeon’s experience on speech outcome in cleft lip and palate. Lancet. 1999;354(9191):1697–1698.
137.
WilliamsWNSeagleMBPegoraro-KrookMISouzaTVGarlaLSilvaMLMachado NetoJSDutkaJCRNackashiJBoggsS, et al.Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck palatoplasties for UCLP. Ann Plastic Surg. 2011;66(2):154–163.
138.
YangYLiYWuYYifeiGUHengYHuLBingSQianZ. Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. J Craniofac Surg. 2013;24(3):923–928.
139.
YsunzaAPamplonaMCMendozaMGarcía-VelascoMAguilarMPGuerreroME. Speech outcome and maxillary growth in patients with unilateral complete cleft lip/palate operated on at 6 versus 12 months of age. Plastic Reconst Surg. 1998;102(3):675–679.
