Outcomes of cleft palatal repair for internationally adopted children.

BACKGROUND

Families in the United States adopted approximately 230,000 foreign-born children over the past two decades. Age at adoption and the presence of a cleft palate impact speech and language development. The authors' purpose is to document speech outcome after palatal closure in internationally adopted children.

METHODS

The authors reviewed internationally adopted children with cleft lip-cleft palate or cleft palate who had two-flap palatoplasty from 1987 to 2010. Data collected included date of birth, cleft palatal type, age at palatoplasty, palatal fistula, postoperative speech assessment, and need for secondary surgery.

RESULTS

The authors identified 55 children adopted with unrepaired cleft palate. Palatal types were Veau I (n = 1), II (n = 1), III (n = 37), or IV (n = 16). Median age at palatoplasty was 25.6 ± 11.8 months; palatal fistula occurred in five patients (9 percent). Speech outcome was successful in 28 patients (51 percent), whereas a secondary operation was recommended for 27 patients (49 percent). Need for a secondary operation was independent of palatal type (p = 0.6). Children who required a pharyngeal flap were significantly older at the time of palatoplasty compared with those who did not (p = 0.009). There was a significant association between increasing age at palatoplasty and need for a secondary operation (OR, 1.07; 95 percent CI, 1.01 to 1.13; p = 0.01). Pharyngeal flap significantly improved speech (p < 0.001).

CONCLUSIONS

International adoption with late palatoplasty can result in disordered speech. Velopharyngeal insufficiency is associated with increasing age at palatoplasty. The authors recommend palatoplasty and speech therapy soon after adoption.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.