Our Summary

This research paper discusses cleft lip and palate, a common birth defect that can cause speech difficulties in children. Even after surgery, these speech issues can persist and affect a child’s development. The paper explores various surgical techniques to improve speech outcomes for children with a cleft palate.

The findings suggest that two particular surgical methods, the two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty, have been shown to be most effective in improving speech. It’s preferable to perform these surgeries when the child is between 10-14 months old, as waiting longer can lead to more significant speech problems.

In cases where speech problems continue after the operation, three techniques (pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation) are equally effective. The choice of technique should depend on the specific details of the cleft and the size of the gap between the soft palate and the back of the throat.

The paper concludes by suggesting future research should focus on using standardized measures and stronger study designs.

FAQs

  1. What are the most effective surgical techniques for improving speech in children with a cleft palate?
  2. At what age is it preferable to perform these surgeries to prevent significant speech problems?
  3. What techniques are recommended when speech problems continue after the operation?

Doctor’s Tip

A doctor may advise a patient undergoing cleft palate surgery to follow post-operative care instructions carefully, including proper wound care and attending follow-up appointments. They may also recommend working with a speech therapist to help improve speech outcomes after surgery. It’s important for patients to be patient and consistent with therapy to see the best results.

Suitable For

Patients who are typically recommended cleft palate surgery are infants and children with cleft lip and palate birth defects. The surgery is usually recommended to improve speech outcomes and correct any structural abnormalities in the palate that may affect feeding, breathing, and overall development. The optimal age for surgery is between 10-14 months old, but surgery can also be performed later in childhood or even in adulthood if necessary. It is important to consult with a team of specialists, including pediatricians, otolaryngologists, speech therapists, and plastic surgeons, to determine the best course of treatment for each individual patient.

Timeline

Before cleft palate surgery:

  • Patient is diagnosed with cleft lip and/or palate at birth
  • Patient may have difficulty feeding and may experience ear infections due to the opening between the mouth and nose
  • Patient may experience speech difficulties as they grow older

After cleft palate surgery:

  • Surgery is typically performed when the child is between 10-14 months old
  • Patient undergoes surgery to repair the cleft palate, which may involve techniques such as two-flap palatoplasty with IVVP or Furlow double-opposing Z-plasty
  • Recovery period following surgery involves monitoring for complications and ensuring proper healing
  • Speech therapy may be recommended to help improve speech outcomes post-surgery
  • In cases where speech problems persist, additional surgical techniques such as pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation may be considered
  • Long-term follow-up is necessary to monitor speech development and address any ongoing issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft palate surgery may include:

  1. What are the different surgical techniques available for cleft palate repair?
  2. What is the best age for my child to undergo cleft palate surgery?
  3. What are the potential risks and complications associated with cleft palate surgery?
  4. How long is the recovery process after cleft palate surgery?
  5. Will my child require speech therapy after the surgery?
  6. What are the expected speech outcomes following cleft palate surgery?
  7. Are there any long-term effects or considerations we should be aware of?
  8. How experienced is the surgical team in performing cleft palate surgeries?
  9. Are there any alternative treatments or therapies that may benefit my child?
  10. What follow-up care will be needed after cleft palate surgery?

Reference

Authors: Lindeborg MM, Shakya P, Rai SM, Shaye DA. Journal: Curr Opin Otolaryngol Head Neck Surg. 2020 Aug;28(4):206-211. doi: 10.1097/MOO.0000000000000635. PMID: 32520757