Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands.
Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
Clin Oral Investig. 2024 Jul 24;28(8):441. doi: 10.1007/s00784-024-05828-7.
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.
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.
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.
唇腭裂（CL/P）修复后，患儿可能出现腭咽闭合不全（VPI），导致言语缺陷，需要进行额外的语音矫正手术。本研究旨在探讨 Sommerlad 腭裂修补术后 VPI 的发生率和语音矫正手术情况，并分析其与各种临床特征的相关性。
这是一项在乌得勒支威廉敏娜儿童医院进行的回顾性队列研究，对 2008 年至 2017 年间登记的 380 例 CL/P 患儿的病历进行了回顾性分析。纳入标准为：CL/P 诊断、Sommerlad 技术的初次腭裂修复术和 5 岁及以上的语音评估。采用比值比和卡方检验评估裂隙类型和宽度、是否存在其他遗传疾病及术后并发症（腭部裂开、瘘管）与裂隙类型和宽度的相关性。
共纳入 239 例患儿。VPI 发生率为 52.7%（n=126），119 例患儿（49.8%）行语音矫正手术。Veau 分级较高提示为重度裂隙，与更高的语音矫正手术率显著相关（p=0.033）。裂隙宽度>10mm的患儿行语音矫正手术的比例显著高于裂隙宽度≤10mm的患儿（p<0.001）。存在口鼻瘘的患儿行语音矫正手术的比例显著高于无瘘管的患儿（p=0.004）。有或无遗传疾病的患儿行语音矫正手术的比例无显著差异（p=0.890）。
结论/临床相关性：裂隙形态、裂隙宽度和并发症（如口鼻瘘）的差异与不同的语音结果相关。未来的研究应重点建立一个多变量预测模型，以预测 CL/P 患者行语音矫正手术的可能性。
