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

―Evaluation after hard palate closure―

Abstract

 Purpose: In two-stage palatal repair, the soft palate and the posterior half of the hard palate are closed at 1 year 6 months in the first operation. In the second, closure of the residual anterior half of the hard palate and alveolar bone grafting are performed simultaneously at 6-7 years of age. We evaluated the impact of this procedure on speech function.
 Methods: The subjects were 36 consecutively treated patients with complete unilateral cleft lip and palate. Patients underwent the first and second operation at a mean age of 1 year 8 months and 6 years 8 months, respectively. After the first operation, 18 patients did not wear a palatal plate as an obturator (non-plate group) as the unclosed cleft reduced remarkably in the anterior half of the hard palate. A total of 18 patients wore a palatal plate (plate group) as the unclosed cleft was opened widely and there was nasal emission, affecting adequate articulation. Velopharyngeal closure function (VPC) and articulation were evaluated at a mean age of 5 years 1 month and 7 years 5 months before (age 5) and after the second operation (post-2nd), respectively, and we considered the non-plate and plate groups.
 Results: In all cases, the acquisition rate of excellent and good VPC was 88.9％ at age 5 and 94.4％ at post-2nd. The acquisition rate of acceptable and intelligible speech (adequate articulation) increased from 44.4％ at age 5 to 61.1％ at post-2nd. The acquisition rate of excellent and good VPC in the plate group was significantly lower at 77.8％ compared to 100％ in the non-plate group at age 5. VPC was good with no significant difference at 94.4％ in both groups at post-2nd. No significant difference was observed in the acquisition rate of adequate articulation in the non-plate (55.6％) and plate group (33.3％) at age 5. The acquisition rate increased to 83.3％ in the non-plate group but remained significantly low at 38.9％ and showed no improvement in the plate group at post-2nd.
 Conclusions: Half of all cases that were able to avoid the use of a palatal plate obtained good VPC at age 5 and adequate speech outcome in almost all cases at post-2nd. Articulation disorder in the other half that needed to use the palatal plate did not improve even at post-2nd. To facilitate speech development without delay, an unclosed cleft should be reduced to the appropriate size without adversely affecting VPC acquisition before 5 years of age at the latest.