Speech outcome evaluation in post-cleft palate closure patients with two flaps pushback technique

https://doi.org/10.22146/majkedgiind.63117

Irma Kusumawati(1*), Andri Hardianto(2), Agus Nurwiadh(3)

(1) Program Study of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java
(2) Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java
(3) Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java
(*) Corresponding Author

Abstract


Speech quality is an essential output in assessing the success of a palatoplasty. The goal of a palatoplasty is not merely to create a simple anatomical closure of the palate, but also to create an adequate velopharyngeal mechanism for a normal speech outcome and to prevent abnormal maxillofacial development after surgery. The aim of this study is to find out the difference in speech outcome between post-cleft palate closure patients and patients without cleft palate. An analytical retrospective study was conducted on 22 children (n = 22) with complete unilateral cleft palate, who had been treated using two flap push back technic of palatoplasty during 2014-2017 by purposive sampling method, and 22 children without cleft palate as the control group. The evaluation of speech outcome was done using an assessment of perception by doing a speech pathologist and instrumental examination by taking a lateral cephalometry radiograph. The perception was assessed by the articulation pattern, hypernasality, and speech intelligibility. The lateral cephalometry radiograph was taken at /i/ phonation to measure the distance velum to the posterior pharynx wall. Data were analyzed using Mann Whitney test. The velopharyngeal competence in post-palatoplasty group consisted of 22.8% adequate result, 0.1% marginal result, and 68.1% inadequate result. Meanwhile, in the control group, there were 72.7% adequate and 27.3% inadequate competence. According to the result of the statistical test, this study concluded that there was a significant difference in speech outcome based on articulation pattern, hypernasality, speech intelligibility, and velopharyngeal distance between post-cleft palate closure patients and patients without cleft palate (p < 0.05). Majority of patients after cleft palate closure with two flaps pushback technique had inadequate velopharyngeal competence with moderate-severe hypernasality, severe nasal emission, abnormal speech intelligibility, and velopharyngeal distance ≥ 5.0 mm, whereas the majority of control group had an adequate velopharyngeal competence.

Keywords


cleft palate; cleft palate closure; palatoplasty; speech outcome; two flap push back

Full Text:

PDF


References

1. Zhang Z, Zhang P, Li S, Cheng J, Yuan H, Jiang H. Skeletal, dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate. Int J Oral Maxillofac Surg. 2021; 50(6): 774-781.
doi: 10.1016/j.ijom.2020.09.010

2. Timbang MR, Gharb BB, Rampazzo A, Papay F, Zins J, Doumit G. A systematic review
comparing furlow double opposing z-plasty and straight-line intravelar veloplasty methods
of cleft palate repair. Plast Reconstr Surg. 2014; 134(5): 1014-1022.
doi: 10.1097/PRS.0000000000000637

3. Naidu P, Yao CA, Chong DK, Magee WP. Cleft palate repair: a history of techniques and
variations. Plast Reconstr Surg Glob Open. 2022; 10(3): e4019.
doi: 10.1097/GOX.0000000000004019

4. Altaweel AA, Abdelkader A, Mohamed RS. Effect of two-flap palatoplasty on
growth and speech in patients with a cleft palate. Tanta Dent J. 2016; 13(2): 96-101.
doi: 10.4103/1687-8574.188912

5. Dong Y, Dong F, Zhang X, Hao F, Shi P, Ren G, Yong P, Guo Y. An effect comparison
between Furlow double opposing Z-plasty and two-flap palatoplasti on velopharyngeal
closure. Int J Oral Maxillofac Surg. 2012; 41(5): 604-611. doi: 10.1016/j.ijom.2012.01.010

6. Sakran KA, Liu R, Yu T, Al-Rokhami RK, He D. A comparative study of three palatoplasty
techniques in wide cleft palates. Int J Oral Maxillofac Surg. 2021; 50(2): 191-197.
doi: 10.1016/j.ijom.2020.07.016

7. Kummer AW. Types and causes of velopharyngeal dysfunction. Semin Speech Lang. 2011; 32(2): 150-158. doi: 10.1055/s-0031-1277717.

8. Aparna VS, Pushpavathi M, Bonanthaya K. Velopharyngeal closure and resonance in
children following early cleft palate repair: outcome measurement. Indian J Plast Surg.
2019; 52(2): 201-208. doi: 10.1055/s-0039-1696608.

9. Manosudprasit M, Wangsrimongkol T, Kitsahawong S, Thienkosol T. Comparison of the modified Huddart/Bodenham and GOSLON yardstick methods for assessing outcomes following primary surgery for unilateral cleft lip and palate. J Med Assoc Thai. 2011; 94(S6): S15-20.

10. Djoenaedi I, Handayani S, Wahyuni LK, Bangun K. Speech outcome evaluation after two-flap palatoplasti in plastic surgery division Cipto Mangunkusumo Hospital: a retrospective study. Jurnal Plastik Rekonstruksi (JPR). 2012; 1(2): 153-158.doi: https://doi.org/10.14228/jpr.v1i2.49

11. Yang IY, Liao YF. The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review. Int J Oral Maxillofac Surg. 2010; 39(10): 945-
950. doi: 10.1016/j.ijom.2010.04.053

12. Adani S, Cepanec M. Sex differences in early communication development: behavioral and
neurobiological indicators of more vulnerable communication system development in boys.
Croat Med J. 2019; 60(2): 141-149. doi: 10.3325/cmj.2019.60.141.

13. Shprintzen RJ. The velopharyngeal mechanism. Dalam: Berkowitz S, ed. Cleft lip
and palate diagnosis and management. 3thed. Chicago: Springer; 2013. 741–757.

14. Safaiean A, Jalilevand N, Ebrahimipour M, Asleshirin E, Hiradfar M. Speech intelligibility
after repair of cleft lip and palate. Med J Islam Repub Iran. 2017; 31: 85.
doi 10.14196/mjiri.31.85

15. Sullivan SR, Marrinan EM, Mulliken JB. Pharyngeal flap outcomes in nonsyndromic
children with repaired cleft palate and velopharyngeal insufficiency. Plast Reconstr
Surg. 2010; 125(1): 290-298. doi: 10.1097/
PRS.0b013e3181c2a6c1

16. Rajesh Yellinedi, Mukunda Reddy Damalacheruvu. Is there an optimal resting
velopharyngeal gap in operated cleft palate patients? Indian J Plast Surg. 2013; 46(1): 87-
91. doi: 10.4103/0970-0358.113716

17. Evayani LD, Tofani I, Hak MS. Comparison of sensitivity and specificity of mirror test and
cephalometry in assessing velopharyngeal insufficiency after reconstruction of cleft
palate. Journal of Physics: Conference Series. 2018; 1073(4): 1-5.
doi: 10.1088/1742-6596/1073/4/042006.

18. Kummer AW. Management of velopharyngeal insufficiency: The evolution of care and the
current state of the art. Journal of Cleft Lip Palate and Craniofacial Anomalies. 2019;
6(2): 65-72. doi: 10.4103/jclpca.jclpca_10_19



DOI: https://doi.org/10.22146/majkedgiind.63117

Article Metrics

Abstract views : 591 | views : 693

Refbacks

  • There are currently no refbacks.




Copyright (c) 2022 Majalah Kedokteran Gigi Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


 

 View My Stats


real
time web analytics