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Speech Results and Speech Development after Two-Stage Palatoplasty Combined with Hotz's Plate in Cleft Lip and Palate Children
Shinsaku Isono
Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University
(Chief: Prof. Yasushi Ohashi)
Abstract
Velopharyngeal competency and articulation in 70 patients with cleft lip and palate were examined over a period of years following two-stage palatoplasty combined with Hotz's plate, and were investigated the outcome of this treatment in terms of speech condition on the basis of evaluations at the age of 8 years.
The results were shown below.
1. Velopharyngeal competency at 8 years of age was competent in 84.3%, marginal in 5.7%, incompetent in 10.0%, indicating favorable velopharyngeal competency in most subjects. Chronological follow-up of velopharyngeal competency revealed marked long-term improvement even after the hard palate closure operation, which was the characteristic of this treatment system.
2. Fifty-three subjects (75.7) have achieved normal articulation at 8 years of age. Normal articulation developed without the occurrence of compensatory articulation in 6 subjects, compensatory articulation transiently occurred but spontaneously improved in 12 subjects, and articulation treatment had been completed in 35. While quite a few subjects required articulation treatment, appropriate therapy resulted in favorable improvement by the age of 8 years.
3. It should be suitable to evaluate speech results at the age of 8 years, when the hard palate closing surgery had been completed and velopharyngeal competency had become stable. This study suggested that the results speech therapy must be included in evaluation, and that speech therapy is important in this treatment system.
These findings indicate that two-stage palatoplasty combined with Hotz's plate is a treatment system that requires a variety of types of elaborate care, and that an elaborate treatment plan and long-term care are also necessary to speech therapy. It is possible to achieve normal development of the jaw and normal speech with this treatment system, if appropriate medical treatment is provided and satisfactory speech therapy is included as part of the team approach.