Speech Outcomes of Submucous Cleft Palate: Speech Evaluation and Timing of Operation

Abstract

ABSTRACT Background: Patient with submucous cleft palate (SMCP) does not need routine surgical repair, because a significant number of patients will not develop velopharyngeal insufficiency (VPI). Surgeries are consequently delayed until speech can be assessed. However, surgical treatment in SMCP was reported ineffective in improving speech due to timing of operation. The speech outcomes were reviewed in a group of patients who were treated according to speech evaluation results. The incidence of VPI and speech outcomes in SMCP were assessed. Materials and Methods: A retrospective study was performed for 18 patients with SMCP who were treated in Seoul National University Childrens Hospital (SNUCH) from January 2005 to January 2015. Timing and outcome of speech evaluation, history of surgical treatment and speech therapy were reviewed. Surgeries were only performed to patients with SMCP who were confirmed as having VPI by speech evaluation. All patients with VPI were operated using Furlow double opposing Z-palatoplasty, and followed by postoperative speech therapy accordingly. Results: Incidence of VPI was 56% (10/18). Surgical intervention was performed to all 10 patients with VPI, and mean age at operation was 51.6 months (4.3y

range, 29-119 months). All 10 (100%) operated patients achieved competent velopharyngeal (VP) function. 9 out of 10 operated patients were treated with speech therapy postoperatively, and articulation errors were corrected in 89% (8/9). Conclusion: The present study proposed to treat patients with SMCP accordingly, after speech evaluation was conducted at an adequate age. It may be relatively late in timing to perform palatoplasty after confirmation of VPI through speech evaluation, yet would be effective in VPI correction. Postoperative speech therapy is beneficial to articulation of patients with SMCP.