A Survey of the Management of Submucous Cleft Palate Among Surgeons and Speech Pathologists in Australia and New Zealand

Abstract

Background

Submucous cleft palate (SMCP) is a rare condition with a variable symptomatology. While in overt cleft palate, earlier repair is associated with superior speech outcomes, this is not always possible as many patients with SMCP present at an older age. There is controversy in how patients with SMCP who present at a young age should be treated because it is difficult to differentiate which patients will be symptomatic and which will be asymptomatic later in life. Because of this, we anticipate that even within a small population geographical region such as Australia and New Zealand, that there may be variation in SMCP is managed. We surveyed surgeons and speech pathologists in Australia and New Zealand to determine how SMCP is managed by different providers.

Method

A web-based, 9 question survey was developed and sent to 52 cleft surgeons and 39 cleft speech pathologists in Australia and New Zealand, with questions about practice duration and location, preferred operative techniques, follow up duration and follow up type, and three clinical scenarios involving patients with SMCP.

Results

Eighteen of 52 (35%) surgeons and 21 of 39 (54%) speech pathologists responded. There were differences in preferred surgical technique, follow-up duration, and indications for surgical intervention. There was disagreement in how to manage prelingual patients with SMCP, with 39% of surgeons repairing these patients early to prevent the development of cleft speech patterns, 22% of surgeons opting for early repair if there were other symptoms such as nasal regurgitation or otitis media with effusion, and 39% electing to wait for speech development. By contrast, only 10% of speech pathologists recommended early surgery, 40% recommended early surgery in the presence of other symptoms, and 50% recommended observation until speech development.

Conclusion

There is a wide variation in the preferred management of SMCP in Australia and New Zealand. This may reflect the wide range in symptomology of this patient population, or the clinical equipoise between various management strategies based on the current body of evidence.