PURPOSE: Management of patients with unilateral or bilateral complete cleft lip and palate using early soft palate closure at the time of cleft lip repair followed by hard palate closure at 10–18 months old has been advocated for improving speech and audiology outcomes, although this has not been previously investigated. This study performs a comparative review of speech and audiology outcomes for single-stage and 2-stage palate repairs for patients with complete cleft lip and associated cleft palate.
MATERIALS AND METHODS: A retrospective chart review identified patients with diagnosis of cleft lip with associated complete cleft palate who underwent either single or 2-stage repair from 2006 to 2012. Data collected included age at each surgery, necessity of further speech surgery for velopharyngeal insufficiency, frequency of tympanostomy tube placement, and most recent audiology and speech assessment data including hypernasality and intelligibility, which were graded per the validated Americleft speech scale. Subset statistical analysis was performed comparing single-stage and 2-stage groups for unilateral and bilateral patients.1,2
RESULTS: A total of 91 patients were identified and subdivided into groups of unilateral single-stage, bilateral single-stage, unilateral 2-stage, and bilateral 2-stage repairs. Mean age at the time of single-stage palate repair was 13.3 months. For the 2-stage group, mean ages were 4.2 and 11.8 months for the soft palate and hard palate repairs, respectively. Mean age at most recent speech assessment was 4.72 years for all patients. Speech surgeries were required for 5.9% (n = 2/32) of single-stage patients and 2% (n = 1/47) of 2-stage patients although this difference was not significant. The 2-stage unilateral group showed significant improvement in intelligibility versus the single-stage group (0.59 versus 1.37; P < 0.05), but no significant discrepancy with hypernasality. The 2-stage bilateral group showed significant improvement in intelligibility versus the single-stage group (0.79 versus 2.17; P < 0.05), but no significant discrepancy with hypernasality. Mean age at last audiologic assessment was 6.17 years. No significant difference was noted between groups with respect to hearing loss or tympanostomy rates.
CONCLUSION: Early 2-stage palatal closure is a viable method for improving early speech development in patients undergoing repair of unilateral and bilateral cleft lip and cleft palate. No significant benefit was achieved with respect to audiologic outcomes or tympanostomy rates.
1. Morén S, Lindestad PÅ, Holmström M, et al. Voice quality in adults treated for unilateral cleft lip and palate: long-term follow-up after one- or two-stage palate repair. Cleft Palate Craniofac J. 2018;55:1103–1114.
2. Reddy RR, Gosla Reddy S, Vaidhyanathan A, et al. Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review. J Craniomaxillofac Surg. 2017;45:995–1003.