Alighieri Cassandra, Hodges Andrew, Verbeke Jolien, Kestens Katrien, Bettens Kim, Albite Rica, May Tan Raphaelle, Lierde Kristiane Van
Department of Rehabilitation Sciences, Centre of Speech and Language Sciences, Ghent University, Gent, Belgium.
Tebow Cure Hospital, Davao City, Philippines.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13146. doi: 10.1111/1460-6984.13146.
Adults presenting with unrepaired cleft palate are not a rare occurrence in middle-income countries. However, many surgeons are hesitant to operate on these individuals because of the challenges in repairing the wide adult cleft palate, as well as concerns regarding any improvement in speech in older patients. Unfortunately, the literature on the effect of delayed palatal closure is scarce.
To investigate the effect of delayed palatal closure on speech and self-reported satisfaction in Filipino adults born with a cleft palate.
METHODS & PROCEDURES: A total of 17 adults (mean age = 23.31 years) who underwent delayed palatal closure in the Philippines (a middle-income country) using a three-step surgical procedure (palatal repair, buccinator flaps and suspension pharyngeal flap) were included in this study. Pre- and post-operative speech assessments were conducted. Nasalance values and the absence or presence of velopharyngeal insufficiency (VPI) were determined using the nasometer and videofluoroscopic assessments, respectively. A self-report questionnaire was administered to evaluate satisfaction with the procedure and their speech.
OUTCOMES & RESULTS: Statistically significant improvements in speech understandability and speech acceptability were observed after delayed palatal closure. With regard to resonance and nasal airflow, the presence of hypernasality and nasal emission significantly decreased post-surgery. Videofluoroscopic data showed improved velopharyngeal closure following delayed palatal closure. Participants reported that their speech was significantly more intelligible in different contexts. No differences in articulation were observed before and after surgery.
CONCLUSIONS & IMPLICATIONS: Considering the positive speech outcomes in terms of speech understandability, speech acceptability, hypernasality, nasal emission, velopharyngeal closure and self-reported satisfaction, it is worthwhile to operate on adults with unrepaired palatal clefts. Post-operative speech therapy to improve articulation remains necessary.
What is already known on the subject Adults presenting with unrepaired cleft palate are not a rare occurrence in middle-income countries. However, many surgeons are hesitant to operate on these individuals because of challenges in repairing the wide adult cleft palate as well as concerns regarding any improvement in speech in older patients. What this paper adds to the existing knowledge This study investigated the effect of delayed palatal closure on speech and self-reported satisfaction in Filipino adults born with a cleft palate. We described the use of a unique three-step surgical procedure including palatal repair, buccinator flaps and suspension pharyngeal flap. Significant improvements in speech understandability and speech acceptability were observed after delayed palatal closure using this three-step surgical sequence. The presence of hypernasality and nasal emission significantly decreased post-surgery and improved velopharyngeal functioning was observed. What are the potential or clinical implications of this work? It is worthwhile to operate on adults with unrepaired palatal clefts considering the positive speech outcomes in terms of speech understandability, speech acceptability, hypernasality, nasal emission, velopharyngeal functioning and self-reported satisfaction. Post-operative speech therapy to improve articulation remains necessary.
在中等收入国家，成年腭裂未修复患者并不罕见。然而，由于修复成人宽大腭裂存在挑战，以及对老年患者语音改善情况的担忧，许多外科医生对这类患者进行手术时犹豫不决。不幸的是，关于延迟腭裂修复效果的文献很少。
研究延迟腭裂修复对菲律宾成年腭裂患者语音及自我报告满意度的影响。
本研究纳入了17名在菲律宾（一个中等收入国家）接受延迟腭裂修复手术的成年人（平均年龄=23.31岁），采用三步手术法（腭裂修复、颊肌瓣和悬雍垂咽瓣）。进行术前和术后语音评估。分别使用鼻音计和视频荧光镜评估来确定鼻漏气值以及是否存在腭咽闭合不全（VPI）。发放一份自我报告问卷以评估对手术及其语音的满意度。
延迟腭裂修复术后，语音可懂度和语音可接受性有统计学意义的显著改善。关于共鸣和鼻气流，术后高鼻音和鼻漏气的情况显著减少。视频荧光镜数据显示延迟腭裂修复术后腭咽闭合改善。参与者报告称他们的语音在不同情境下明显更易理解。手术前后发音无差异。
考虑到在语音可懂度、语音可接受性、高鼻音、鼻漏气、腭咽闭合和自我报告满意度方面的积极语音结果，对成年腭裂未修复患者进行手术是值得的。术后仍需要进行语音治疗以改善发音。
关于该主题已有的知识 在中等收入国家，成年腭裂未修复患者并不罕见。然而，由于修复成人宽大腭裂存在挑战，以及对老年患者语音改善情况的担忧，许多外科医生对这类患者进行手术时犹豫不决。本文对现有知识的补充 本研究调查了延迟腭裂修复对菲律宾成年腭裂患者语音及自我报告满意度的影响。我们描述了一种独特的三步手术法的应用，包括腭裂修复、颊肌瓣和悬雍垂咽瓣。使用这种三步手术顺序进行延迟腭裂修复术后，语音可懂度和语音可接受性有显著改善。术后高鼻音和鼻漏气的情况显著减少，且观察到腭咽功能改善。这项工作的潜在或临床意义是什么？考虑到在语音可懂度、语音可接受性、高鼻音、鼻漏气、腭咽功能和自我报告满意度方面的积极语音结果，对成年腭裂未修复患者进行手术是值得的。术后仍需要进行语音治疗以改善发音。
