Influence of timing of hard palate repair in a two-stage procedure on early speech development in Danish children with cleft palate.

Objective: To investigate the influence of timing of hard palate closure on early speech development from 18 months to 3 years of age.

Design: A prospective, randomized clinical trial.

Participants: Thirty-four children with unilateral cleft lip and palate (UCLP) with velum closure at 4 months of age, and hard palate closure at 12 months (early hard palate repair, EarlyHPR) or 36 months (late hard palate unrepaired, LateHPU) by random assignment. Thirty-five control children were matched for gender and age.

Methods: All children were video recorded during a play interaction with a parent at 18 months of age. These recordings were transcribed according to the International Phonetic Alphabet. At 36 months a single word naming test was administered.

Results: At 18 months the LateHPU group produced fewer labial stops and more velar stops than the EarlyHPR group. Unlike the EarlyHPR group, the LateHPU group produced fewer vocalizations, consonants, and consonants permissible in word-initial position than the control group. Additionally, both cleft palate groups had a smaller productive vocabulary than the control group, but unlike the EarlyHPR group, the LateHPU group produced a smaller number of word tokens in social interaction than the control group. By 3 years of age, the LateHPU group had a (severely) restricted phonological system and produced more cleft speech characteristics than the EarlyHPR group.

Conclusions: Surgical timing of hard palate repair in a two-stage procedure appears to have an influence on early speech development in children with cleft palate.