DELAYED CLOSURE OF THE HARD PALATE - A COMPARISON OF SPEECH IN CHILDREN WITH OPEN AND FUNCTIONALLY CLOSED RESIDUAL CLEFTS

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.