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Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors.
J Plast Surg Hand Surg. 2017 Feb; 51(1):38-51.JP

Abstract

BACKGROUND AND AIM

Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols 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, Norway, Sweden, 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 non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments.

RESULTS

In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p = .045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p = .01).

CONCLUSIONS

PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. 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 Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark.b Division of Speech and Language Pathology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.c Division of Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden. d Institute of Neuroscience and Physiology, Speech and Language Pathology Unit , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.e Division of Speech and Language Pathology , Linköping University , Linköping , Sweden.f Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Helsinki , Finland.g Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.h Copenhagen Cleft Palate Centre , University Hospital of Copenhagen , Denmark.h Copenhagen Cleft Palate Centre , University Hospital of Copenhagen , Denmark.i Greater Manchester Cleft Unit , Royal Manchester Childrens' Hospital , Manchester , UK.i Greater Manchester Cleft Unit , Royal Manchester Childrens' Hospital , Manchester , UK.j Cleft Palate Centre , Aarhus , Denmark.k Cleft Palate Team , Sahlgrenska University Hospital , Gothenburg , Sweden.l The Royal Hospital for Sick Children , Belfast , Northern Ireland.m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.n Statped Vest , Bergen , Norway.e Division of Speech and Language Pathology , Linköping University , Linköping , Sweden.j Cleft Palate Centre , Aarhus , Denmark.g Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.l The Royal Hospital for Sick Children , Belfast , Northern Ireland.m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.f Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Helsinki , Finland.n Statped Vest , Bergen , Norway.n Statped Vest , Bergen , Norway.n Statped Vest , Bergen , Norway.h Copenhagen Cleft Palate Centre , University Hospital of Copenhagen , Denmark.h Copenhagen Cleft Palate Centre , University Hospital of Copenhagen , Denmark.g Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.g Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway. o Dental School , University of Manchester , Manchester , UK. p Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Review

Language

eng

PubMed ID

28218556

Citation

Willadsen, Elisabeth, et al. "Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 5. Speech Outcomes in 5-year-olds - Consonant Proficiency and Errors." Journal of Plastic Surgery and Hand Surgery, vol. 51, no. 1, 2017, pp. 38-51.
Willadsen E, Lohmander A, Persson C, et al. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors. J Plast Surg Hand Surg. 2017;51(1):38-51.
Willadsen, E., Lohmander, A., Persson, C., 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: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors. Journal of Plastic Surgery and Hand Surgery, 51(1), 38-51. https://doi.org/10.1080/2000656X.2016.1254647
Willadsen E, et al. Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 5. Speech Outcomes in 5-year-olds - Consonant Proficiency and Errors. J Plast Surg Hand Surg. 2017;51(1):38-51. PubMed PMID: 28218556.
* 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: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors. AU - Willadsen,Elisabeth, AU - Lohmander,Anette, AU - Persson,Christina, 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 - Andersen,Helene Søgaard, 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 - Primary palatal repair KW - cleft speech characteristics KW - consonant proficiency KW - randomised clinical trial KW - unilateral cleft lip and palate SP - 38 EP - 51 JF - Journal of plastic surgery and hand surgery JO - J Plast Surg Hand Surg VL - 51 IS - 1 N2 - BACKGROUND AND AIM: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols 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, Norway, Sweden, 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 non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. RESULTS: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p = .045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p = .01). CONCLUSIONS: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. 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/28218556/Scandcleft_randomised_trials_of_primary_surgery_for_unilateral_cleft_lip_and_palate:_5__Speech_outcomes_in_5_year_olds___consonant_proficiency_and_errors_ L2 - http://www.tandfonline.com/doi/full/10.1080/2000656X.2016.1254647 DB - PRIME DP - Unbound Medicine ER -