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

IF 1.5 3区医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

International Journal of Language & Communication Disorders Pub Date : 2024-12-13 DOI:10.1111/1460-6984.13146

Cassandra Alighieri, Andrew Hodges, Jolien Verbeke, Katrien Kestens, Kim Bettens, Rica Albite, Raphaelle May Tan, Kristiane Van Lierde

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

菲律宾成年人腭部延迟闭合后语言能力是否有所改善？联合腭修复术、颊侧皮瓣和悬吊咽皮瓣的效果。

背景：在中等收入国家，成人腭裂未修复的情况并不罕见。然而，由于修复宽大的成人腭裂是一项挑战，而且担心老年患者的言语能力是否会得到改善，许多外科医生对是否为这些患者进行手术犹豫不决。遗憾的是，有关延迟腭裂闭合术效果的文献很少。目的：研究延迟腭裂闭合术对菲律宾先天性腭裂成人的言语能力和自我满意度的影响：本研究共纳入了17名成年人（平均年龄=23.31岁），他们在菲律宾（中等收入国家）接受了三步手术（腭裂修复、颊舌骨瓣和悬吊咽瓣）的延迟腭闭合术。研究人员进行了术前和术后言语评估。鼻腔平衡值和是否存在咽喉发育不全（VPI）分别通过鼻腔测量仪和视频荧光屏评估来确定。此外，还进行了自我报告问卷调查，以评估患者对手术和言语的满意度：延迟腭部闭合术后，言语理解能力和言语可接受性均有明显改善。在共鸣和鼻气流方面，手术后鼻音过重和鼻漏明显减少。视频荧光屏数据显示，延迟腭部闭合术后，咽喉闭合情况有所改善。参加者表示，他们在不同语境下说话的清晰度明显提高。手术前后在发音方面没有发现差异：考虑到在言语可理解性、言语可接受性、低鼻音、鼻腔排放、腭咽闭合和自我报告满意度方面的积极言语效果，值得为未修复腭裂的成人进行手术。术后仍需进行语言治疗以改善发音：相关知识在中等收入国家，成人腭裂未修复的情况并不罕见。然而，由于修复宽大的成人腭裂存在困难，而且担心老年患者的言语能力能否得到改善，许多外科医生对是否为这些患者进行手术犹豫不决。本文对现有知识的补充本研究调查了延迟腭部闭合对菲律宾先天性腭裂成人的言语能力和自我满意度的影响。我们介绍了一种独特的三步手术方法，包括腭裂修复、颊舌骨皮瓣和悬吊咽皮瓣。采用这种三步手术顺序进行延迟腭咽闭合术后，患者的语言理解能力和语言可接受性得到了显著改善。术后鼻音过重和鼻漏现象明显减少，咽喉功能也得到改善。这项研究的潜在或临床意义是什么？考虑到在言语可理解性、言语可接受性、低鼻音、鼻音、咽喉功能和自我报告满意度等方面的积极言语效果，值得对未修复腭裂的成人进行手术。术后仍有必要进行言语治疗以改善发音。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Language & Communication Disorders AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

3.30

自引率

12.50%

发文量

116

审稿时长

6-12 weeks

期刊介绍： The International Journal of Language & Communication Disorders (IJLCD) is the official journal of the Royal College of Speech & Language Therapists. The Journal welcomes submissions on all aspects of speech, language, communication disorders and speech and language therapy. It provides a forum for the exchange of information and discussion of issues of clinical or theoretical relevance in the above areas.