Does speech improve after delayed palatal closure in Filipino adults? Effects of combined palatal repair, buccinator flaps and suspension pharyngeal flap.

BACKGROUND

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.

AIMS

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 THIS PAPER ADDS

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.