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Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate.
Br J Oral Maxillofac Surg. 2013 Dec; 51(8):845-50.BJ

Abstract

We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n=20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n=20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p=0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p=0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p=0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p=0.019). No patients in the Talmant group had an oronasal fistula (p<0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.

Authors+Show Affiliations

Département de chirurgie orthopédique et plastique pédiatrique, Hôpital Lapeyronie, CHRU Montpellier, France; Department of Oral and Maxillofacial Surgery, Dalhousie University, Halifax, Canada.No 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

23742818

Citation

Doucet, Jean-Charles, et al. "Speech Outcomes of Early Palatal Repair With or Without Intravelar Veloplasty in Children With Complete Unilateral Cleft Lip and Palate." The British Journal of Oral & Maxillofacial Surgery, vol. 51, no. 8, 2013, pp. 845-50.
Doucet JC, Herlin C, Captier G, et al. Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate. Br J Oral Maxillofac Surg. 2013;51(8):845-50.
Doucet, J. C., Herlin, C., Captier, G., Baylon, H., Verdeil, M., & Bigorre, M. (2013). Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate. The British Journal of Oral & Maxillofacial Surgery, 51(8), 845-50. https://doi.org/10.1016/j.bjoms.2013.04.016
Doucet JC, et al. Speech Outcomes of Early Palatal Repair With or Without Intravelar Veloplasty in Children With Complete Unilateral Cleft Lip and Palate. Br J Oral Maxillofac Surg. 2013;51(8):845-50. PubMed PMID: 23742818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate. AU - Doucet,Jean-Charles, AU - Herlin,Christian, AU - Captier,Guillaume, AU - Baylon,Hélène, AU - Verdeil,Mélanie, AU - Bigorre,Michèle, Y1 - 2013/06/03/ PY - 2013/01/11/received PY - 2013/04/22/accepted PY - 2013/6/8/entrez PY - 2013/6/8/pubmed PY - 2015/2/20/medline KW - Cleft lip KW - Cleft palate KW - Intravelar veloplasty KW - Speech KW - Surgical technique SP - 845 EP - 50 JF - The British journal of oral & maxillofacial surgery JO - Br J Oral Maxillofac Surg VL - 51 IS - 8 N2 - We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n=20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n=20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p=0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p=0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p=0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p=0.019). No patients in the Talmant group had an oronasal fistula (p<0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers. SN - 1532-1940 UR - https://www.unboundmedicine.com/medline/citation/23742818/Speech_outcomes_of_early_palatal_repair_with_or_without_intravelar_veloplasty_in_children_with_complete_unilateral_cleft_lip_and_palate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0266-4356(13)00159-9 DB - PRIME DP - Unbound Medicine ER -