SPEECH OUTCOME AFTER CLEFT-PALATE SURGERY WITH THE GOTEBORG REGIMEN INCLUDING DELAYED HARD PALATE CLOSURE

The regimen for treatment of children with cleft lip and palate in Got eborg, Sweden, until 1996 included early soft palate repair at 6-8 mon ths of age and delayed closure of the hard palate at about 8 years of age to improve maxillary growth. The aims of this report were to descr ibe the treatment concept and to present speech data of 59 children tr eated by this method. The speech of 38 children with unilateral and 21 with bilateral cleft lip and palate was evaluated perceptually from s tandardised tape recordings of repeated sentences and spontaneous spee ch at five ages from 3 to 16 years of age. All patients were not evalu ated at each age level. The results showed a low prevalence of hyperna sality after hard palate closure and pharyngeal flap surgery in only f ive children (8%), indicating a primary velopharyngeal insufficiency i n less than 10% of the children. Only three children with bilateral cl efts had glottal articulation when at pre-school age and no child with a unilateral cleft did. These results were interpreted as an indicati on of velopharyngeal competence (VPC) in most of the children. In addi tion, the speech problem found in these children consisted of retracte d oral articulation of alveo-dental pressure plosives, which is almost always an indicator of VPC. However, we do consider that retracted or al articulation is a problem and to improve our results further we hav e decided to modify the technique for soft palate closure slightly and place the vomer flap further anteriorly to encourage narrowing of the cleft in the hard palate, and to close the hard palate at 3 years of age.