Abstract
Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/.ObjectivesDescribe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty. Material and MethodsA sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age. ResultsThe use of middorsum palatal place (MDP) of production was identified for 2% of the sample. Tongue anteriorization of the /l/ production was observed for 55% of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040). ConclusionWe found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/.
Highlights
Cleft lip and palate (CLP) is a common congenital anomaly, occurring at a frequency EHWZHHQ DQG ELUWKV17
When cleft involves the palate, either as an isolated cleft palate (CP) or cleft lip and palate (CLP), oral communication can be severely affected E\ VSHHFK DQG KHDULQJ GLVRUGHUV ZLWK LPSOLFDWLRQV for nutrition and psychosocial and educational GHYHORSPHQW DV ZHOO DV IDFLDO DHVWKHWLFV 7KH FRPPXQLFDWLRQ GLVRUGHUV DVVRFLDWHG ZLWK &3 PD\ be due to several factors: (1) unoperated cleft, (2) velopharyngeal dysfunction (VPD) resulting from the failure of the primary surgery to establish a functional velopharyngeal mechanism, (3) dentoocclusal conditions, and (4) hearing loss due to associated chronic otitis media, among other factors
Authors suggest that the technique used for primary palatoplasty and the age of the FKLOG DW SDODWRSODVW\ KDYH D UHODWLRQVKLS ZLWK WKH occurrence of speech and hearing disorders in FKLOGUHQ ZLWK &/3 RU 93'13,18
Summary
Cleft lip and palate (CLP) is a common congenital anomaly, occurring at a frequency EHWZHHQ DQG ELUWKV17. When a crossbite is present, IRU H[DPSOH WKH MDZ PD\ EH SURWUXGHG EH\RQG WKH maxilla and the tongue and may be inadequately DQWHULRUL]HG RU HYHQ FURZGHG EDFNZDUG GHSHQGLQJ RQ KRZ WKH WRQJXH DGMXVWV WR WKH UHPDLQLQJ RUDO VSDFH ,Q VRPH FDVHV ZKHQ WKH WRQJXH SURWUXGHV EH\RQG WKH OLPLWV RI WKH XSSHU MDZ WKH XVH RI the tongue dorsum (instead of the tip) in contact ZLWK WKH PLGGOH RI WKH KDUG SDODWH LQVWHDG RI WKH alveolar region) can be observed for liquid sounds, a production called middorsum palatal (MDP)12 7KDW LV ZKHQ JURZWK GH¿FLHQF\ DQG dento-occlusal abnormalities are the cause of the compensatory adjustment, both MDPS and MDP can be observed. This study investigates consonant error production, including CAs, during liquid sound SURGXFWLRQ .QRZOHGJH UHJDUGLQJ WKH RFFXUUHQFH of consonant production error during liquid sounds is important for the development of prevention DQG LQWHUYHQWLRQ SURJUDPV IRU FKLOGUHQ ZLWK communication disorders related to CLP or VPD. .QRZOHGJH DERXW WKH GLIIHUHQFHV LQ WKH RFFXUUHQFH of consonant error production, including CAs in FKLOGUHQ ZKR XQGHUZHQW SULPDU\ SDODWRSODVW\ E\ different surgical techniques or at different ages DW VXUJHU\ FDQ KHOS GH¿QH WKH EHVW WUHDWPHQW protocols for CLP
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