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Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate.
Cleft Palate Craniofac J. 2020 04; 57(4):420-429.CP

Abstract

AIM

To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair.

DESIGN

Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft).

SETTING

Tertiary health care. One surgical center.

PATIENTS AND METHODS

One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months).

MAIN OUTCOME MEASUREMENTS

Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency.

RESULTS

No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate "cleft size at tuberosity level" was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = -.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99).

CONCLUSIONS

Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

Authors+Show Affiliations

Section of Orthodontics, Aarhus University, Denmark. Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark.Section of Orthodontics, Aarhus University, Denmark. Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark.Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark.Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark.Section of Orthodontics, Aarhus University, Denmark. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark.Department of Plastic Surgery and Burns Treatment, University Hospital of Copenhagen, Denmark.Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31505955

Citation

Botticelli, Susanna, et al. "Influence of Infant Cleft Dimensions On Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate." The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association, vol. 57, no. 4, 2020, pp. 420-429.
Botticelli S, Küseler A, Mølsted K, et al. Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J. 2020;57(4):420-429.
Botticelli, S., Küseler, A., Mølsted, K., Andersen, H. S., Boers, M., Shoeps, A., Emborg, B. K., Kisling-Møller, M., Pedersen, T. K., Andersen, M., & Willadsen, E. (2020). Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association, 57(4), 420-429. https://doi.org/10.1177/1055665619874143
Botticelli S, et al. Influence of Infant Cleft Dimensions On Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J. 2020;57(4):420-429. PubMed PMID: 31505955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. AU - Botticelli,Susanna, AU - Küseler,Annelise, AU - Mølsted,Kirsten, AU - Andersen,Helene Soegaard, AU - Boers,Maria, AU - Shoeps,Antje, AU - Emborg,Berit Kildegaard, AU - Kisling-Møller,Mia, AU - Pedersen,Thomas Klit, AU - Andersen,Mikael, AU - Willadsen,Elisabeth, Y1 - 2019/09/10/ PY - 2019/9/12/pubmed PY - 2020/9/20/medline PY - 2019/9/12/entrez KW - hard palate KW - nonsyndromic clefting KW - speech development KW - surgical technique KW - velopharyngeal function SP - 420 EP - 429 JF - The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association JO - Cleft Palate Craniofac. J. VL - 57 IS - 4 N2 - AIM: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. DESIGN: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). SETTING: Tertiary health care. One surgical center. PATIENTS AND METHODS: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). MAIN OUTCOME MEASUREMENTS: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. RESULTS: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate "cleft size at tuberosity level" was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = -.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). CONCLUSIONS: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low. SN - 1545-1569 UR - https://www.unboundmedicine.com/medline/citation/31505955/Influence_of_Infant_Cleft_Dimensions_on_Velopharyngeal_Function_in_5_Year_Old_Danish_Children_Born_With_Unilateral_Cleft_Lip_and_Palate_ L2 - https://journals.sagepub.com/doi/10.1177/1055665619874143?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -