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Assessing the impact of palatal fistula formation and cleft width on speech outcomes following double opposing Z-plasty in patients with cleft palate. | LitMetric

Assessing the impact of palatal fistula formation and cleft width on speech outcomes following double opposing Z-plasty in patients with cleft palate.

J Plast Reconstr Aesthet Surg

Department of Plastic Surgery, CHA Bundang Medical Center, Gyeonggi-do, Republic of Korea; Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.

Published: November 2024

AI Article Synopsis

  • - This study examined how the formation of palatal fistulas (PF) after a specific surgery (double opposing Z-plasty) impacts speech outcomes in cleft palate patients, specifically looking at cleft width and palatal length as predictors of velopharyngeal insufficiency (VPI).
  • - Researchers analyzed data from 1,117 cleft palate patients treated between 1988 and 2017, finding that while 96.5% achieved socially acceptable speech, those with a history of PF had worse speech outcomes, including higher rates of hypernasality and nasal emission.
  • - The findings suggest that a wider cleft gap is a stronger predictor of speech difficulties post-surgery than the presence of PFs, indicating that

Article Abstract

Objective: This retrospective study investigated the influence of palatal fistula (PF) formation after double opposing Z-plasty (DOZ) on speech outcomes in patients with cleft palate (CP), focusing on cleft width and palatal length as predictors of velopharyngeal insufficiency (VPI).

Methods: This study included 1117 patients with CP (579 males, 538 females) who underwent DOZ, performed by a single surgeon, between 1988 and 2017. Demographic characteristics, cleft dimensions, history of PF formation, and speech outcomes were investigated. Speech evaluations were performed at a minimum age of five to assess nasal emission, hypernasality, compensatory articulation, intelligibility, necessity for VPI surgery, and speech therapy. Logistic regression analysis was performed.

Results: Speech assessments were conducted at the median age of five (interquartile range [IQR], 5-6 years). Overall, 96.5% of patients achieved 'socially acceptable speech' after DOZ. Patients with PF history showed greater cleft width and experienced higher rates of hypernasality, nasal emission, and VPI on videofluoroscopy (VFS) compared to those without PF history (mean, 11.4 mm vs. 7.1 mm; 28.4% vs. 23.6%; 34.8% vs. 14.9%, 38.5% vs. 14.0%, 40.6% vs. 28.3%, respectively; all p < 0.0001). Cleft width was significantly associated with VPI-related speech outcomes in the multivariate logistic regression analysis, affecting both perceptual and VFS-measured outcomes.

Conclusions: A wider CP gap significantly increased the risk of VPI-related speech difficulties after DOZ. Cleft width is a more critical predictor of adverse speech outcomes than the presence of small-to-medium-sized PFs. Patients with a history of PF and wider cleft gaps require targeted interventions and intensified follow-up to effectively manage and improve speech outcomes.

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Source
http://dx.doi.org/10.1016/j.bjps.2024.08.054DOI Listing

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