A recent study conducted at the Wilhelmina Children’s Hospital in Utrecht sheds light on the prevalence of velopharyngeal insufficiency (VPI) and subsequent speech correcting surgeries in children who have undergone Sommerlad’s palatoplasty for cleft lip and/or palate (CL/P). This investigation delves into the relationship between various clinical features and the necessity for additional surgical intervention to correct speech imperfections.
Study Overview and Methodology
The study retrospectively reviewed records of 380 individuals diagnosed with CL/P from 2008 to 2017. Out of these, 239 patients met the inclusion criteria, which included undergoing primary palatoplasty using Sommerlad’s technique and having a speech assessment at the age of five or older. The analysis aimed to identify correlations between cleft characteristics, genetic disorders, and postoperative complications with the incidence of VPI and the need for further speech surgeries.
Key Findings and Associations
The results revealed that 52.7% of the patients experienced VPI, and nearly half (49.8%) required speech correcting surgery. A significant finding was that patients with severe cleft types, as indicated by a higher Veau classification, had a higher likelihood of needing additional speech surgeries (p = 0.033). Similarly, those with cleft widths greater than 10 mm faced a significantly increased rate of speech surgeries compared to those with narrower clefts (p
From a market access perspective, these findings underscore the importance of tailored surgical approaches and postoperative care plans to optimize speech outcomes in CL/P patients. This insight can guide healthcare providers in resource allocation and intervention strategies, ensuring that patients with more complex cleft types and complications receive the necessary surgical attention.
Inferences
Key Inferences:
• A higher Veau classification is a significant predictor for the need for additional speech surgeries.
• Cleft width greater than 10 mm markedly increases the likelihood of requiring further speech corrective procedures.
• Presence of oronasal fistula is associated with an elevated rate of subsequent speech surgeries.
• Genetic disorders do not significantly affect the incidence of speech correcting surgeries, suggesting other clinical features play a more critical role.
This study highlights the intricate relationship between cleft morphology, postoperative complications, and speech outcomes. Future research is recommended to develop a multivariable prediction model to better anticipate the need for speech correcting surgeries in CL/P patients, potentially improving individualized care and market access strategies.
Original Article:
Clin Oral Investig. 2024 Jul 24;28(8):441. doi: 10.1007/s00784-024-05828-7.
ABSTRACT
OBJECTIVES: After cleft lip and/or palate (CL/P) repair, children may develop velopharyngeal insufficiency (VPI) leading to speech imperfections, necessitating additional speech correcting surgery. This study examines the incidence of VPI and speech correcting surgery after Sommerlad’s palatoplasty for CL/P, and its association with various clinical features.
MATERIALS AND METHODS: A retrospective cohort study was performed in the Wilhelmina Children’s Hospital in Utrecht and child records from 380 individuals with CL/P registered from 2008 to 2017 were retrospectively reviewed. Inclusion criteria comprised the diagnosis of CL/P, primary palatoplasty according to Sommerlad’s technique, and speech assessment at five years or older. Association between cleft type and width, presence of additional genetic disorders and postoperative complications (palatal dehiscence, fistula) were assessed using odds ratios and chi squared tests.
RESULTS: A total of 239 patients were included. The VPI rate was 52.7% (n = 126) and in 119 patients (49.8%) a speech correcting surgery was performed. Severe cleft type, as indicated by a higher Veau classification, was associated with a significant higher rate of speech correcting surgeries (p = 0.033). Significantly more speech correcting surgeries were performed in patients with a cleft width >10 mm, compared to patients with a cleft width ≤10 mm (p < 0.001). Patients with oronasal fistula underwent significantly more speech correcting surgeries than those without fistula (p = 0.004). No statistically significant difference was found in the incidence of speech correcting surgery between patients with and without genetic disorders (p = 0.890).
CONCLUSIONS/CLINICAL RELEVANCE: Variations in cleft morphology, cleft width and complications like oronasal fistula are associated with different speech outcomes. Future research should focus on creating a multivariable prediction model for speech correcting surgery in CL/P patients.
PMID:39046574 | DOI:10.1007/s00784-024-05828-7

This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.