2016 Volume 41 Issue 1 Pages 8-16
The purpose of this study was to investigate the speech outcomes of adult patients with repaired cleft lip and palate (CLP) via retrospective analysis of long-term, longitudinal follow-up data. The subjects were 40 patients (21 males and 19 females). Ten had a bilateral CLP, and 30 had a unilateral CLP. They had undergone a modified V-Y pushback method for primary palate repair at 1 year of age by multiple plastic surgeons on the Showa University Cleft Palate Team (SCPT) from 1978 to 1995. Perceived velopharyngeal function (VPF) and presence of articulation disorder were assessed by three experienced speech-language-hearing therapists using the Japanese Assessment of Cleft Palate Speech and the Japanese Assessment of Articulation. The age at speech evaluation was distributed among five periods: 3 to 5 years (I), 6 to 7 years (II), 9 to 12 years (III), 13 to 18 years (IV), and over 19 years (V). The results were as follows:
1. Of the 40 patients, good/normal VPF was judged in 27 (67.5%) at I but in 19 (47.5%) at V. In contrast, slight VPD was judged in 6 (15.5%) at I and in 18 (45.0%) at V. 37 patients (92.5%) were considered as having velopharyngeal competence for daily conversation at V.
2. A change in VPF at II or later was found in 31 patients (77.5%). The tendency of VPF deterioration was frequent at III and IV, but improvement was frequent at II and V.
3. Normal articulation was judged in 18 (45.0%) at I. Articulation disorder was judged in 9 at II or later, but all the subjects acquired normal articulation again at V.
4. 21 of 22 (95.5%) with articulation disorders had received speech therapy from I to II, and half of the subjects achieved normal articulation at III or later.
5. Palatalized articulation was most frequent, with 11 at I and 6 at V.
6. The number of patients judged with normal articulation was 28 (70.0%) at V.
It is not possible to predict VPF at adulthood only from perceived VPF at childhood. From the results of this study, speech re-evaluation was considered to be necessary at age around 10, 16, and 20 at completion of treatment regardless of VPF at childhood.
Acquisition of normal articulation in individuals with repaired CLP continued until adulthood after speech therapy at childhood. For this reason, continued follow-up and speech intervention should be effective for achieving normal articulation.
