Keiko Okazaki

Speech and velopharyngeal function following maxillary advancement in patients with cleft lip and palate

The influence of maxillary advancement by osteotomy on speech was examined in 10 patients with cleft palates (6 males, 4 females). Ages at the time of surgery ranged from 16 to 26 years (mean, 19.5 yr). LeFort I and II osteotomies were performed in 9 patients and 1 patient, respectively. Preoperatively and postoperatively, hypernasality, nasal emission on pressure consonants, and articulation disturbances were evaluated perceptually, and velopharyngeal function was evaluated by lateral cephalographic and nasopharyngoscopic studies. Hypernasality, which had been judged preoperatively to be absent or slight in 1 patient each, remained unchanged after surgery, whereas the remaining 8 patients showed increased hypernasality after surgery. Nasal emission showed a similar tendency. Articulation errors were not improved postoperatively. Lateral cephalograms recorded from the patients with increased hypernasality showed increases in the shortest palatopharyngeal length and in the soft-palate-length–to–pharyngeal-depth ratio. Also, deterioration in velopharyngeal closure was noted postoperatively compared with preoperatively by nasopharyngoscopy in the majority of patients with increased hypernasality.

Palate morphology in children with cleft palate with palatalized articulation.

This study was designed to examine postoperatively morphological characteristics of the palate of children with cleft palate with palatalized articulation. Palate morphology was measured in children with good velopharyngeal closure function after surgery, who were classified in Hellmans Dental Age II A group with unilateral cleft lip and palate, and the groups of children with palatalized articulation (CP-P) and normal articulation (CP-N) were compared. The results showed that the group of children with palatalized articulation was characterized by small palatal volume. In particular, there was narrowing and shortening of the anterior palate, and the palate was shallow. It was surmised that morphology may be one cause of palatalized articulation. Accordingly, it is important that early tongue-clicking movements are encouraged in patients exhibiting narrow palate morphology.

A new cleft palate repair

Cleft palate can be repaired by a palatal mucoperiosteal flap, but we have devised a new technique for cleft palate repair using a wide mucoperiosteal flap with an alveolar ridge mucosa and a cleft margin flap. This technique leaves the mucosa of the nasal cavity and vomer intact. The results include (1) good velopharyngeal competence and normal articulation, (2) few cases of fistula formation, and (3) minimal maxillary retardation.

Results of Systematic Speech Sound Monitoring in Children with Cleft Palate

Using our monitoring system, we report the articulation results in 208 children with competent velopharyngeal function after surgery of cleft palate. The number of children who showed normal articulation at each test during the monitoring period was 138. The other 79 children included 37 who acquired normal articulation after training and whose misarticulation disappeared without training. Factors related to their misarticulation are discussed.