Recent Progress in Treating Patients with Cleft Palate

Abstract

Over the last 4 decades remarkable progress has been made in the treatment of cleft palate: the rate of attaining normal or nearly normal speech after surgery has risen from about 65% 40 years ago to nearly 90% or more nowadays. One of the main factors is intratracheal intubation anesthesia that has made the surgery much safer and easier. Improved surgical technique and speech therapy also played a great role. This paper deals with two problems: (1) Slight velopharyngeal incompetence: The combined use of fiberscopy and fluorovideoscopy can provide useful information as to: (a) the exact place of the faulty articulation, (b) the detailed pattern of inconsistent velopharyngeal function, (c) changes in articulation induced by speech therapy, and (d) the relation between velopharyngeal function and faulty articulation. All the above information greatly facilitates speech therapy for cleft palate speech. It should be done with utmost care though due to possible adverse effects of radiation. (2) Analysis of faulty articulation. It was revealed that faulty articulations such as laryngeal fricative and affricates, pharyngeal stop, and glottal stop in cleft palate speech, secondary to velopharyngeal incompetence, were produced by articulation in the larynx at various sites such as the epiglottis, arytenoids, aryepiglottic folds and vocal folds. These faulty articulation points were located lower than supposed on the basis of auditory perception.