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Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality.
J Plast Surg Hand Surg. 2017 Feb; 51(1):27-37.JP

Abstract

BACKGROUND AND AIM

Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy.

DESIGN

Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.

METHODS

Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments.

RESULTS

There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%.

CONCLUSIONS

No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

TRIAL REGISTRATION

ISRCTN29932826.

Authors+Show Affiliations

a Division of Speech and Language Pathology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden.b Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Division of Speech and Language Pathology , Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.c Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark.d Division of Speech and Language Pathology , Linköping University , Linköping , Sweden.e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland.f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark.g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark.h Department of Plastic Surgery, Greater Manchester Cleft Unit , Royal Manchester Children's Hospital , Manchester , UK.h Department of Plastic Surgery, Greater Manchester Cleft Unit , Royal Manchester Children's Hospital , Manchester , UK.i Cleft Palate Center , Aarhus , Denmark.j Division of Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden.k The Royal Hospital for Sick Children , Belfast , Northern Ireland.l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.m Statped Vest , Bergen , Norway.e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland.i Cleft Palate Center , Aarhus , Denmark.f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.k The Royal Hospital for Sick Children , Belfast , Northern Ireland.l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland.m Statped Vest , Bergen , Norway.m Statped Vest , Bergen , Norway.m Statped Vest , Bergen , Norway.g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark.g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark.f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway. n School of Dentistry , University of Manchester , Manchester , UK. o Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28218551

Citation

Lohmander, Anette, et al. "Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 4. Speech Outcomes in 5-year-olds - Velopharyngeal Competency and Hypernasality." Journal of Plastic Surgery and Hand Surgery, vol. 51, no. 1, 2017, pp. 27-37.
Lohmander A, Persson C, Willadsen E, et al. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality. J Plast Surg Hand Surg. 2017;51(1):27-37.
Lohmander, A., Persson, C., Willadsen, E., Lundeborg, I., Alaluusua, S., Aukner, R., Bau, A., Boers, M., Bowden, M., Davies, J., Emborg, B., Havstam, C., Hayden, C., Henningsson, G., Holmefjord, A., Hölttä, E., Kisling-Møller, M., Kjøll, L., Lundberg, M., ... Semb, G. (2017). Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality. Journal of Plastic Surgery and Hand Surgery, 51(1), 27-37. https://doi.org/10.1080/2000656X.2016.1254645
Lohmander A, et al. Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 4. Speech Outcomes in 5-year-olds - Velopharyngeal Competency and Hypernasality. J Plast Surg Hand Surg. 2017;51(1):27-37. PubMed PMID: 28218551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality. AU - Lohmander,Anette, AU - Persson,Christina, AU - Willadsen,Elisabeth, AU - Lundeborg,Inger, AU - Alaluusua,Suvi, AU - Aukner,Ragnhild, AU - Bau,Anja, AU - Boers,Maria, AU - Bowden,Melanie, AU - Davies,Julie, AU - Emborg,Berit, AU - Havstam,Christina, AU - Hayden,Christine, AU - Henningsson,Gunilla, AU - Holmefjord,Anders, AU - Hölttä,Elina, AU - Kisling-Møller,Mia, AU - Kjøll,Lillian, AU - Lundberg,Maria, AU - McAleer,Eilish, AU - Nyberg,Jill, AU - Paaso,Marjukka, AU - Pedersen,Nina Helen, AU - Rasmussen,Therese, AU - Reisæter,Sigvor, AU - Søgaard Andersen,Helene, AU - Schöps,Antje, AU - Tørdal,Inger-Beate, AU - Semb,Gunvor, PY - 2017/2/21/entrez PY - 2017/2/22/pubmed PY - 2017/12/16/medline KW - Randomised clinical trial KW - Scandcleft KW - cross-linguistic KW - intercentre study KW - primary palatal repair KW - speech KW - unilateral cleft lip and palate SP - 27 EP - 37 JF - Journal of plastic surgery and hand surgery JO - J Plast Surg Hand Surg VL - 51 IS - 1 N2 - BACKGROUND AND AIM: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. RESULTS: There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. CONCLUSIONS: No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed. TRIAL REGISTRATION: ISRCTN29932826. SN - 2000-6764 UR - https://www.unboundmedicine.com/medline/citation/28218551/Scandcleft_randomised_trials_of_primary_surgery_for_unilateral_cleft_lip_and_palate:_4__Speech_outcomes_in_5_year_olds___velopharyngeal_competency_and_hypernasality_ L2 - http://www.tandfonline.com/doi/full/10.1080/2000656X.2016.1254645 DB - PRIME DP - Unbound Medicine ER -