Influence of infant cleft dimensions on velopharyngeal function in 5-year-old Danish children born with unilateral cleft lip and palate.

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Documents

  • Susanna Botticelli
  • Annelise Küseler
  • Mikael Andersen
  • Kirsten Mølsted
  • Antje Schops
  • Maria Boers
  • Berit Emborg
  • Thomas Klit Petersen
  • Line Dahl Jørgensen
  • Helene Søgaard Andersen
  • Mia Kisling-Møller
  • Willadsen, Elisabeth
Aim:
To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair.

Design:
Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft).

Setting:
Tertiary health care. One surgical center.

Patients and Methods:
One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months).

Main outcome measurements:
Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency.

Results:
No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99).

Conclusions:
Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

Keywords nonsyndromic clefting, speech development, velopharyngeal function, hard palate, surgical technique
Original languageEnglish
JournalCleft Palate - Craniofacial Journal
ISSN1055-6656
Publication statusE-pub ahead of print - 10 Sep 2019

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