Speech Outcome in Patients with Cleft Lip and Palate Following Two-stage Palatoplasty

—At the Age of 4 and 5 Years—

Abstract

We have performed modified two-stage palatoplasty since November 2003. In the first operation of two-stage palatal repair, not only the soft palate but also the posterior half of the hard palate is closed simultaneously using modified Furlow's method. The purpose of this study was to evaluate retrospectively the speech outcome at 4 and 5 years of age for patients treated by this procedure.
The subjects were 39 consecutively treated patients with unilateral and bilateral cleft lip and palate, who underwent the first operation of two-stage palatal repair at 18 to 25 months of age (mean age: 20.4) from November 2003 to August 2008. Eighteen of the 39 patients (46.2%) wore a palatal plate postoperatively.
Velopharyngeal competency was competent in 87.2% at 4 years of age and in 89.7% at 5 years of age. The incidence of articulation disorders was 59.0% at 4 years of age and 56.4% at 5 years of age. At the age of 4 years, palatalized misarticulation was observed most frequently, followed by glottal stop, nasopharyngeal misarticulation, lateral misarticulation and pharyngeal fricatives, at 50.0%, 35.7%, 7.1%, 3.6% and 3.6%, respectively. At the age of 5 years, the same tendency was seen: palatalized misarticulation 48.0%, glottal stop 32.0%, lateral misarticulation 16.0% and pharyngeal fricatives 4.0%.
Velopharyngeal competency was relatively good and the incidence of articulation disorders was low in the previous reports of domestic centers adopting two-stage palatoplasty. It is thought that narrowing of the remaining oro-nasal communication in the hard palate is facilitated because the palatal closure at the first operation of two-stage palatoplasty is performed on the posterior half of the hard palate from the soft palate, thus reducing adverse effects for articulation.