Title : Speech outcome in patients with unilateral cleft lip and palate submitted to two different palatoplasty protocols
Abstract:
Aim: The main goal of cleft palate repair is to accomplish good speech with preservation of the maxillary growth. Speech and language disorders are an important issue of treatment failures. During the speech, Velopharyngeal Deficiency (VPD) may occur. Patients with Late Hard Palate Closure (LHPC) showed an increased rate of VPD compared to patients with Early Palate Repair (EPR) in some researches Aim Evaluate the speech outcomes in children with unilateral cleft lip and palate (UCLP) who were operated by a single surgeon in a single-center using two different treatment protocols, one a two staged repair with Hard Palate Late Closure(HPLC) and a Control Group with EPR Methods A randomized, controlled, blinded trial was carried out at CADEFI between January 2010 and October 2016 and evaluate speech outcomes in two groups of subjects with UCLP through auditory-perceptual assessment by three experienced speech-language pathologists(SLP) at a different Institution. The intervention group (IG), had two stages of repair with LHPC, between 3 and 4 years of age (32 patients), and the control group (CG) with early one-stage repair between 9 to 15 months (28 patients). Speech samples were collected and recorded in a standardized manner following Brazilcleft recommendations. For the auditory-perceptual assessment was considered: compensatory articulation disorders (CAD) and hypernasality (present and absent). The unweighted kappa was calculated for the compensatory articulation disorder an hypernasality.
Results: Compensatory articulations were absent in 18(56,25%) patients for the IG and in 19(67,86%) patients in a CG. Interrater reliability was calculated for the three SLP raters. Resonance adequated were verified in both groups: GI=32 46,88%(15), mean=1,5(SD± 0,5070), GC=28(60,71%(17),mean=1,6 and SD±0,4973.
Conclusion: The findings suggested that the compensatory articulation rate was similar in both groups. The agreement level for the three SLP raters showed better results for the Control Group revealing a lower frequency of hypernasality, although without statistical difference.
Audience Takes Away Notes:
- Randomized controlled trials are important for decision-making by health professionals.
- The importance of the influence of primary surgeries in individuals with cleft lip and palate for facial growth and speech results
- The centralization of the treatment of cleft lip and palate in Reference Centers, with a multi and interdisciplinary team, is important, offering a complete and humanized service with the objective of promoting better results for this population. Explain how the audience will be able to use what they learn?
