Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
Cleft Palate Craniofac J. 2020 Oct;57(10):1197-1215. doi: 10.1177/1055665620923925. Epub 2020 May 21.
To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol.
A retrospective, descriptive, cross-sectional consecutive series.
A regional twin site center; a district general hospital and tertiary children's hospital.
Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate.
Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad.
Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented.
A VPC-SUM CAPS-A score of "0" was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI.
Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
报告采用 Sommerlad 术式早期完全腭裂修复术后 5 岁时的语音和腭咽功能（VPF）结果以及手术特点。
回顾性、描述性、横断面连续系列研究。
区域双胞胎中心；一家地区综合医院和一家三级儿童医院。
1993 年至 2006 年期间，877 名参与者接受了手术；712 名（81%）符合纳入标准；391 名（55%）纳入研究，321 名（45%）排除。13%为双侧唇腭裂（BCLP），40%为单侧唇腭裂（UCLP），47%为单纯腭裂。
3 月龄时行唇和犁骨瓣修复（BCLP、UCLP），6.6 月龄时行软腭裂根治性肌切开和后位术（4-23 月龄），术式由 Sommerlad 描述并实施。
采用腭裂语音评估协议-语音增强版（Cleft Audit Protocol for Speech-Augmented）分析得到的腭咽复合（VPC）CAPS-A 评分和构音总结评分。
97%的患者 VPC-SUM CAPS-A 评分为“0”，提示腭咽功能良好；73%的患者无腭裂构音困难。BCLP 组构音效果最差。二次语音手术率为 2.6%，10.7%的患者行瘘管修复。提上唇肌质量和后位程度与与 VP 相关的语音结局相关。2.6%的患者目前存在 VP 特征。
由描述该技术的外科医生在 6 月龄左右完成腭裂完全修复，可导致患者在 5 岁时获得良好的感知 VPF 和非常好的语音效果，接受的语音治疗和二次语音手术比常规报道的更少。这些发现为 Sommerlad 术式和技术提供了一个基准。
