Speech Outcomes in Children with Robin Sequence Treated with a Pre-Epiglottic Baton Plate

Abstract

Objective To analyze speech outcomes and cleft shape changes in children diagnosed with Robin sequence (RS) treated with a customized pre-epiglottic baton plate (PEBP). Design Single-surgeon retrospective analysis. Setting Tertiary care institution. Patients and Participants Twenty-five patients with RS who were treated with PEBP and primary cleft palate repair between 2010 and 2019. Interventions Postnatal use of a PEBP. Main Outcome Measures Speech assessment at the age of 3.5 to 4.5 years documenting hypernasality, nasal emission, nasal turbulence, voice quality, and consonant production, and analysis of digitally scanned cast models before and after the use of PEBP to quantify changes in cleft shape and width. Results The study cohort ( N = 25) consisted of 19 patients with hard and soft cleft palates and 6 patients with soft cleft palate only and postnatal use of PEBP. The mean reduction in cleft width following PEBP treatment prior to cleft palate repair in 19 infants with hard and soft cleft palates was 41.30% (standard deviation, 13.25). Speech assessments were conducted at a mean age of 48.5 months in all 25 children treated with PEBP. Most children presented with absent or mild hypernasality (96%), a rate of 8% of nasal emission and 4% of nasal turbulence was found. The most frequent findings were articulation errors in 14 children (56%), of whom 2 presented with cleft-type characteristics. Conclusions Children with RS and cleft palate treated with PEBP demonstrated a narrowing of the cleft palate prior to a timely surgical repair, and favorable speech outcomes already at a young age during childhood.