2001 Volume 42 Issue 2 Pages 145-155
The purpose of this study was to compare speech results in 18 patients who had undergone delayed hard-palate closure (two-stage operation, TSO) with those in 22 patients who had undergone early complete closure (one-stage operation, OSO) . The average age of the TSO was 1 year 8 months at closure of the soft palate and 5 years 8 months at closure of the hard palate. The TSO patients had worn a palatal plate between the first and second operation to cover the hard palate openings as well as to improve their speech.
At 4 years old, before hardpalate closure, slight nasal escape was observed in many patients. However, at 7 years old, after hardpalate closure, all patients except one exhibited good velopharyngeal function. This finding suggests the nasal escape may be due to leakage of air through clefts in spite of wearing a palatal appliance.
The incidence of articulation disorders in patients undergoing the TSO was 88.9%, whereas that of those undergoing the OSO was 59.1%. Eleven patients of the TSO group had glottal stops, 7 had Japanese lateral misarticulation, 4 had Japanese palatalized misarticulation, and 2 had pharyngeal fricatives. Glottal stops were found to disappear gradually without any speech therapy in tandem with improvement in velopharyngeal function. Eleven patients of the TSO group (61.1%) received speech therapy for articulation disorders.
Good velopharyngeal function was ultimately achieved after hard-palate closure, although the incidence of articulation disorders was high. Thus, the TSO method was seemed to yield the satisfactory speech results.
