Speech Results after One-Stage Palatoplasty with or without Muscle Reconstruction for Isolated Cleft Palate

Abstract

Objective

To investigate speech outcome between children with isolated cleft palate undergoing palatoplasty with and without muscle reconstruction and to compare speech outcomes between cleft and noncleft children. The number of subsequent velopharyngeal flaps was compared with respect to surgical techniques and cleft extent.

Design

Cross-sectional retrospective study.

Participants

One hundred four children aged 4 years, 0 months to 6 years, 0 months, 33 with isolated cleft of the soft palate, 53 with isolated cleft of the hard and soft palate, and 18 noncleft children.

Interventions

Two primary palate repair techniques: minimal incision technique (MIT) and minimal incision technique including muscle reconstruction (MIT_mr).

Main Outcome Measures

Perceptual judgment of seven speech parameters assessed on a five-point scale.

Results

No significant differences in speech outcomes were found between MIT and MIT_mr surgery groups. The number of velopharyngeal flaps was significantly lower after MIT_mr surgery compared to MIT surgery. The number of flaps was also significantly lower in children with cleft of the soft palate compared to children with cleft of the hard and soft palate. Children with cleft of the soft palate had significantly less glottal articulation and weak pressure consonants compared to children with cleft of the hard and soft palate.

Conclusions

The MIT_mr surgery technique was not significantly superior to the MIT technique regarding speech outcomes related to velopharyngeal competence, but had fewer velopharyngeal flaps, which is contradictory. Until a larger sample can be studied, we will continue to use MIT_mr for primary palate repair.