A. Lohmanderagerskov et al., DELAYED CLOSURE OF THE HARD PALATE - A COMPARISON OF SPEECH IN CHILDREN WITH OPEN AND FUNCTIONALLY CLOSED RESIDUAL CLEFTS, Scandinavian journal of plastic and reconstructive surgery and hand surgery, 30(2), 1996, pp. 121-127
The speech of 20 children with cleft in the hard palate that had not y
et been repaired was evaluated and analysed at 7 years of age. The cle
ft in the hard palate was open in 14 patients and functionally closed
in six. All children were born with cleft lip and palate and treated s
urgically according to a routine that included delayed closure of the
hard palate until age 8-10 years. The soft palate was repaired at appr
oximately 6-8 months of age. Tape recordings were used for perceptual
analysis of the speech. Maxillary casts were used to assess approximat
e age for functional closure of the residual cleft. Speech results sho
wed only mild hypernasality for both groups of subjects which indicate
s acceptable velopharyngeal function in the whole group. Children with
open residual clefts had significantly more nasal escape and a higher
prevalence of compensatory retracted articulation than children with
functionally closed clefts. The functional closure seems to have occur
red at about the age of 18-36 months. Factors which appear to facilita
te narrowing of the residual cleft include the original width of the c
left, the amount of tissue in the alveolar and palatal processes, and
anterior placement of a vomer flap.