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Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth.
Plast Reconstr Surg 2007; 119(4):1302-10PR

Abstract

BACKGROUND

Hard palate cleft closure has been associated with maxillary hypoplasia. The Schweckendiek procedure offers delayed hard palate closure to avoid early subperiosteal dissection and palatal scarring. This study sought to compare single-stage versus delayed hard palate closure for speech outcome and maxillary growth.

METHODS

A retrospective outcome study was performed of unilateral cleft lip and palate patients with either delayed hard palate repair with a pinned-retained speech prosthesis (Schweckendiek repair) (group 1, delayed hard palate repair, 1978 to 1983) or single-stage cleft palate repair (group 2, single-stage repair, 1983 to 1988). Patients with complete records to maturity at the University of Pittsburgh Cleft Palate Craniofacial Center (n = 82, two equal groups of 41 patients) were studied. Comparative data were collected from multidisciplinary evaluations, perceptual speech scores, speech tests, and cephalometric analysis.

RESULTS

Single-stage cleft palate repair had a lower fistulization rate (11 percent) compared with delayed hard palate repair (58 percent). It also had better speech outcomes compared with delayed hard palate repair: mean speech score, 3.1 versus 7.8; final speech score, 0.9 versus 2.9; velopharyngeal incompetency, 21 percent versus 66 percent; failed video fluoroscopy or nasoendoscopy, 18 percent versus 52 percent; and need for secondary speech procedure, 20 percent versus 63 percent. Single-stage repair showed less maxillary growth disturbance, with class III malocclusion, 31 percent versus 66 percent; cephalometric SNA, 78.2 versus 74.8; need for Le Fort I advancement, 24 percent versus 42 percent; and amount of maxillary advancement required, 6 mm versus 9 mm.

CONCLUSION

The delayed cleft palate repair led to worse speech outcomes; thus, the authors' center abandoned this technique in favor of single-stage repair. In addition, their data showed that the delayed cleft palate repair led to deleterious maxillary growth.

Authors+Show Affiliations

Divisions of Plastic and Reconstructive Surgery of the University of Pittsburgh, Pittsburgh, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17496605

Citation

Holland, Sarah, et al. "Delayed Closure of the Hard Palate Leads to Speech Problems and Deleterious Maxillary Growth." Plastic and Reconstructive Surgery, vol. 119, no. 4, 2007, pp. 1302-10.
Holland S, Gabbay JS, Heller JB, et al. Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plast Reconstr Surg. 2007;119(4):1302-10.
Holland, S., Gabbay, J. S., Heller, J. B., O'Hara, C., Hurwitz, D., Ford, M. D., ... Bradley, J. P. (2007). Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plastic and Reconstructive Surgery, 119(4), pp. 1302-10.
Holland S, et al. Delayed Closure of the Hard Palate Leads to Speech Problems and Deleterious Maxillary Growth. Plast Reconstr Surg. 2007 Apr 1;119(4):1302-10. PubMed PMID: 17496605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. AU - Holland,Sarah, AU - Gabbay,Joubin S, AU - Heller,Justin B, AU - O'Hara,Catherine, AU - Hurwitz,Dennis, AU - Ford,Matthew D, AU - Sauder,Amy S, AU - Bradley,James P, PY - 2007/5/15/pubmed PY - 2007/7/3/medline PY - 2007/5/15/entrez SP - 1302 EP - 10 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 119 IS - 4 N2 - BACKGROUND: Hard palate cleft closure has been associated with maxillary hypoplasia. The Schweckendiek procedure offers delayed hard palate closure to avoid early subperiosteal dissection and palatal scarring. This study sought to compare single-stage versus delayed hard palate closure for speech outcome and maxillary growth. METHODS: A retrospective outcome study was performed of unilateral cleft lip and palate patients with either delayed hard palate repair with a pinned-retained speech prosthesis (Schweckendiek repair) (group 1, delayed hard palate repair, 1978 to 1983) or single-stage cleft palate repair (group 2, single-stage repair, 1983 to 1988). Patients with complete records to maturity at the University of Pittsburgh Cleft Palate Craniofacial Center (n = 82, two equal groups of 41 patients) were studied. Comparative data were collected from multidisciplinary evaluations, perceptual speech scores, speech tests, and cephalometric analysis. RESULTS: Single-stage cleft palate repair had a lower fistulization rate (11 percent) compared with delayed hard palate repair (58 percent). It also had better speech outcomes compared with delayed hard palate repair: mean speech score, 3.1 versus 7.8; final speech score, 0.9 versus 2.9; velopharyngeal incompetency, 21 percent versus 66 percent; failed video fluoroscopy or nasoendoscopy, 18 percent versus 52 percent; and need for secondary speech procedure, 20 percent versus 63 percent. Single-stage repair showed less maxillary growth disturbance, with class III malocclusion, 31 percent versus 66 percent; cephalometric SNA, 78.2 versus 74.8; need for Le Fort I advancement, 24 percent versus 42 percent; and amount of maxillary advancement required, 6 mm versus 9 mm. CONCLUSION: The delayed cleft palate repair led to worse speech outcomes; thus, the authors' center abandoned this technique in favor of single-stage repair. In addition, their data showed that the delayed cleft palate repair led to deleterious maxillary growth. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/17496605/Delayed_closure_of_the_hard_palate_leads_to_speech_problems_and_deleterious_maxillary_growth_ L2 - http://Insights.ovid.com/pubmed?pmid=17496605 DB - PRIME DP - Unbound Medicine ER -