Soft Palate Closure Research Articles

Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers With Cleft Lip and Palate

Abstract Objective: To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. Design: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. Participants: Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. Method: Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their ...

A preliminary ultrasound study of velar fronting

The purpose of this study is to (1) evaluate the effectiveness of ultrasound imaging to measure velar consonant closure location, and (2) conduct a thorough study of velar fronting by measuring several productions of velar stops in the context of every English vowel. Word onset velar stops were measured in both words (CV or CVC) and nonwords (VCV) within a carrier phrase. Other coarticulatory influences were minimized by using words with no coda or labial coda consonants (e.g., ‘‘Say a gap again,’’ ‘‘Say /oIkoI/ again’’). Measurements were made at the point of maximal closure. Closure location was measured using the radial angle from the center of the ultrasound probe to the center of the velar closure. Pilot data for one subject has been analyzed to date. Closure location appears consistent across all central and back vowels. For front vowels, the degree of fronting of the velar appears to be correlated with the frontness of the vowel. Measures of closure location for diphthongs followed the back vowel pattern in the word targets. For nonwords, the closure location was influenced by the preceding diphthong offset quality and the following diphthong onset quality. Theoretical implications for the phonetics/phonology interface will be discussed.

Influences of tongue biomechanics on speech movements during the production of velar stop consonants: a modeling study.

This study explores the following hypothesis: forward looping movements of the tongue that are observed in VCV sequences are due partly to the anatomical arrangement of the tongue muscles, how they are used to produce a velar closure, and how the tongue interacts with the palate during consonantal closure. The study uses an anatomically based two-dimensional biomechanical tongue model. Tissue elastic properties are accounted for in finite-element modeling, and movement is controlled by constant-rate control parameter shifts. Tongue raising and lowering movements are produced by the model mainly with the combined actions of the genioglossus, styloglossus, and hyoglossus. Simulations of V1CV2 movements were made, where C is a velar consonant and V is [a], [i], or [u]. Both vowels and consonants are specified in terms of targets, but for the consonant the target is virtual, and cannot be reached because it is beyond the surface of the palate. If V1 is the vowel [a] or [u], the resulting trajectory describes a movement that begins to loop forward before consonant closure and continues to slide along the palate during the closure. This pattern is very stable when moderate changes are made to the specification of the target consonant location and agrees with data published in the literature. If V1 is the vowel [i], looping patterns are also observed, but their orientation was quite sensitive to small changes in the location of the consonant target. These findings also agree with patterns of variability observed in measurements from human speakers, but they contradict data published by Houde [Ph.D. dissertation (1967)]. These observations support the idea that the biomechanical properties of the tongue could be the main factor responsible for the forward loops when V1 is a back vowel, regardless of whether V2 is a back vowel or a front vowel. In the [i] context it seems that additional factors have to be taken into consideration in order to explain the observations made on some speakers.

Symposium on distraction osteogenesis—point/counterpoint. presented on thursday, september 11, 10:30 am–12:30 pm. moderator: David A. Walker, DDS, MS, FRCD(C), Toronto, Ontario, Canada. : Orthognathic surgery versus distraction osteogenesis in the midface. distraction osteogenesis

The hypoplastic midface is usually advanced by one of the Le Fort osteotomies, with or without additional bone graft in order to re-establish the facial balance and occlusion. However, the maxilla in cleft lip and palate patients is often difficult to mobilize due to scarring from previous operations in the soft or hard palate or lip closure.

Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques.

To assess differences in the aesthetic and functional long-term results of one-stage and two-stage surgical and orthodontic treatment in patients with cleft lip, palate, and alveolus. Sixty adult patients who were operated on as children for unilateral cleft lip, palate, and alveolus were examined. In every patient the lip was closed using Tennison's technique. Thirty patients had soft and hard palate closure in two stages and 30 patients in a single stage. Lateral cephalometric and model analyses were conducted at a mean age of 18.4 years. In the model analysis, transverse narrowing was seen in all patients after two-stage operations and in three patients after one-stage operations. The deficit was more severe in the molar region in the two-stage group and nearly similar in the premolar and molar region in the one-stage group. A sagittal deficiency in the anterior maxilla was found in 26 patients after two-stage operations and in 16 patients after one-stage operations. In the lateral cephalometric analysis, the mean sella-nasion-point A angle in the one- and two-stage group was 78.2 degrees and 76.8 degrees, respectively. The ANB angle was normal in both groups. In both groups the inclination of the midface was low. There was a low posterior facial height. Minor scarring was seen in the single-stage group. A more severe impairment of growth of the maxilla in the sagittal and frontal plane was observed after two-stage operations on the cleft palate.

Cephalometric and Occlusal Outcome in Adults With Unilateral Cleft Lip, Palate, and Alveolus After Two Different Surgical Techniques

Abstract Objective: To assess differences in the aesthetic and functional long-term results of one-stage and two-stage surgical and orthodontic treatment in patients with cleft lip, palate, and alveolus. Design: Sixty adult patients who were operated on as children for unilateral cleft lip, palate, and alveolus were examined. In every patient the lip was closed using Tennison's technique. Thirty patients had soft and hard palate closure in two stages and 30 patients in a single stage. Lateral cephalometric and model analyses were conducted at a mean age of 18.4 years. Results: In the model analysis, transverse narrowing was seen in all patients after two-stage operations and in three patients after one-stage operations. The deficit was more severe in the molar region in the two-stage group and nearly similar in the premolar and molar region in the one-stage group. A sagittal deficiency in the anterior maxilla was found in 26 patients after two-stage operations and in 16 patients after one-stage operations...

Dental arches and occlusion in bilateral cleft lip and palate patients after two different routines for palatal surgery.

Delayed hard palate repair (DHPR) is believed by many researchers to improve maxillary growth and facial appearance in patients born with cleft lip and palate. However, only few studies dealing with the midfacial growth outcome after this type of surgery in bilateral cleft patients have been published. The purpose of this retrospective study was to compare long-term results of maxillary morphology, dental arches and occlusion in two groups of patients with bilateral cleft lip and palate. The palatal surgery differed between the two groups, particularly with respect to the timing of hard palate repair. The DHPR group (n = 16) underwent soft palate closure at 12 months and hard palate repair at around 8 years, whereas the early palatal repair group (EPR) (n = 12) had completed two-stage palatal closure during the first year of life. These latter subjects had undergone more traditional palatal surgery with vomer flaps for repair of the anterior part and push-back closure for the posterior part of the cleft. Surgery was performed in both groups by the same surgical team at Sahlgrenska University Hospital, Göteborg, Sweden. Dental casts were used to analyze the pre- and postoperative maxillary morphology, dental arch dimensions, and occlusion of both samples, which were followed longitudinally from infancy to early adulthood. Differences recorded in both maxillary growth and occlusion were generally in favor of the DHPR group. However, major intragroup variations and relatively small sample sizes precluded statistical verification of the differences, except for development during the early stages.

Nasal nitric oxide.

Nasal nitric oxide.

Gestural timing effects in the ‘‘perfect memory’’ sequence observed under three rates by electromagnetometry

In a well-known example due to Browman and Goldstein [Lab. Phon. I, 341–376 (1990)] the /ktm/ sequence in the phrase ‘‘perfect memory’’ is contrasted between careful (list) and fluent production conditions. X-ray microbeam data were used to show that although in the fluent case coproduction of the /m/ can mask the acoustic releases of the /k/ and /t/, both stops are nonetheless articulated. The current work uses EMMA data to examine this sequence in greater detail: 8 subjects produced the phrase in a carrier context under normal, fast, and clear rate conditions. Results confirm that tongue dorsum and tip movements toward velar and apical closure occur regardless of rate and observable acoustic effect. In addition, while movement amplitudes decreased somewhat as rate increased, little variation in the durations associated with the consonant gestures was observed. Instead, changes in rate primarily effected V to V duration and the relative phasing of the velar and apical closing gestures: the tongue tip maximum (/t/) lagged that of the tongue dorsum (/k/) in clear speech, was aligned with it in normal speech, and generally anticipated it in the fast rate condition. [Work supported by NIH.]

Long-Term Evidence for Favorable Midfacial Growth After Delayed Hard Palate Repair in UCLP Patients

Abstract Objective: To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with “conventional” surgical methods of palatal closure. Design and Setting: Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. Patients: Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. Results and Conclusions: Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then du...

Long-term evidence for favorable midfacial growth after delayed hard palate repair in UCLP patients.

To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with "conventional" surgical methods of palatal closure. Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.

A comparative study of prespeech vocalizations in two groups of toddlers with cleft palate and a noncleft group.

This study examined the prelinguistic contoid (consonant-like) inventories of 14 children with unilateral cleft lip and palate (C-UCLP) at 13 months of age. The children had received primary veloplasty at 7 months of age and closure of the hard palate was performed at 3-5 years. The results of this investigation were compared to results previously reported for 19 children with cleft palate and 19 noncleft children at the age of 13 months. The children with clefts in that study received a two-stage palatal surgery. This surgical procedure was formerly used at our center and included closure of the lip and hard palate at 3 months of age and soft palate closure at 22 months of age. Retrospective study. The participants were videorecorded in their homes during play with their mothers. The videotapes were transcribed independently by three trained speech pathologists. Fourteen consecutive patients born with C-UCLP and no known mental retardation or associated syndromes served as subjects. The children who received delayed closure of the hard palate demonstrated a significantly richer variety of contoids in their prespeech vocalizations than the cleft children in the comparison group. Both groups of subjects with clefts had significantly fewer plosives in their contoid inventory than the noncleft group, and there was no difference regarding place of articulation between the group that received delayed closure of the hard palate and the noncleft group.

A Comparative Study of Prespeech Vocalizations in Two Groups of Toddlers with Cleft Palate and a Noncleft Group

Abstract Objective: This study examined the prelinguistic contoid (consonant-like) inventories of 14 children with unilateral cleft lip and palate (C-UCLP) at 13 months of age. The children had received primary veloplasty at 7 months of age and closure of the hard palate was performed at 3–5 years. The results of this investigation were compared to results previously reported for 19 children with cleft palate and 19 noncleft children at the age of 13 months. The children with clefts in that study received a two-stage palatal surgery. This surgical procedure was formerly used at our center and included closure of the lip and hard palate at 3 months of age and soft palate closure at 22 months of age. Design: Retrospective study. Setting: The participants were videorecorded in their homes during play with their mothers. The videotapes were transcribed independently by three trained speech pathologists. Patients: Fourteen consecutive patients born with C-UCLP and no known mental retardation or associated synd...

Comparisons of facial growth in patients with unilateral cleft lip and palate treated by different regimens for two-stage palatal repair.

The aim of this study was to compare facial development, particularly growth of the maxilla, of two groups of patients with unilateral cleft lip and palate in whom palatal surgery had been done slightly differently, particularly the timing of the procedures. Two-stage palatal repair had been used at 8 (velar closure) and 102 months (hard palate surgery) at one cleft centre and at 20 and 62 months at another centre. Lateral roentgencephalograms were used to analyse the first sample of 20 patients, who were followed longitudinally from 7-16 years of age. The other group comprised 17 subjects in the same age range, who were investigated cross-sectionally, also by cephalometry. Generally, the outcome of the two surgical regimens was similar and equally satisfactory, with no evident difference in facial or maxillary morphology between the two samples. From the midfacial growth point of view, it might be questioned whether it is necessary to delay closure of the cleft in the hard palate until the mixed dentition stage as was done at the first cleft centre.

Exhalation flow and pressure-controlled reservoir collection of exhaled nitric oxide for remote and delayed analysis

BACKGROUNDExpiratory flow rate, soft palate closure, and dead space air may influence exhaled levels of nitric oxide (NO). These factors have not been evaluated in the reservoir collection of NO.METHODSExhaled...

Speech outcome after cleft palate surgery with the Göteborg regimen including delayed hard palate closure.

The regimen for treatment of children with cleft lip and palate in Göteborg, Sweden, until 1996 included early soft palate repair at 6-8 months of age and delayed closure of the hard palate at about 8 years of age to improve maxillary growth. The aims of this report were to describe the treatment concept and to present speech data of 59 children treated by this method. The speech of 38 children with unilateral and 21 with bilateral cleft lip and palate was evaluated perceptually from standardised tape recordings of repeated sentences and spontaneous speech at five ages from 3 to 16 years of age. All patients were not evaluated at each age level. The results showed a low prevalence of hypernasality after hard palate closure and pharyngeal flap surgery in only five children (8%), indicating a primary velopharyngeal insufficiency in less than 10% of the children. Only three children with bilateral clefts had glottal articulation when at pre-school age and no child with a unilateral cleft did. These results were interpreted as an indication of velopharyngeal competence (VPC) in most of the children. In addition, the speech problem found in these children consisted of retracted oral articulation of alveo-dental pressure plosives, which is almost always an indicator of VPC. However, we do consider that retracted oral articulation is a problem and to improve our results further we have decided to modify the technique for soft palate closure slightly and place the vomer flap further anteriorly to encourage narrowing of the cleft in the hard palate, and to close the hard palate at 3 years of age.

Classification, recording, and cleft palate surgery at the Uppsala Cleft Palate Centre.

This paper describes the classification system, method of recording, and surgical techniques used in Uppsala for children with isolated cleft palate. The classification is based on the system described by Kernahan and Stark and the more detailed system described by the American Cleft Palate Association. Separation of the hard palate into thirds, and into right and left sides, assures a detailed description of the cleft, and separates small morphological differences. The longitudinal registration system was introduced into the Uppsala Cleft Palate Centre in 1967. After the initial recording at the time of primary surgery, it is repeated at 5, 8, 11, 14, 17, and 20 years. By emphasising the therapeutic aspects of various stages of growth, it has been possible to limit the recording to once every third year. This has resulted in an important reduction in the dose of radiation without compromising the reliability of the results. Children born before 1975 had clefts of both the soft and hard palate closed at 18-24 months in a one-stage procedure. For children born in 1975 and later a two stage technique has been used, while clefts limited to the soft palate only have been closed entirely in the first operation. At first, the soft palate cleft was closed at 18 months of age and the hard palate at 4 to 5 years. The timing was changed in several steps to the present soft palate closure at 6 months and hard palate closure at 2 years of age.

Bilateral buccal flaps with double opposing Z-plasty for wider palatal clefts.

Described is a technique that has evolved from the challenges of closure of larger cleft palate defects and that we are now using in preference over other techniques to repair a wide variety of clefts. Soft-palate closure and muscular sling reconstruction are accomplished using a modified Furlow technique. An associated cleft of the hard palate and the gaps produced by posterior displacement of the reconstructed soft palate are closed by adding tissue, buccal flaps, rather than by closure under tension or leaving residual raw surfaces. Palate lengthening is achieved both by the Z-plasty effect and by the interposition of buccal flaps between the hard and soft palate. Seventy-six palates have been repaired using this procedure. There were three postoperative fistulas.

Application of the furlow method to primary velar closure in two-stage palatoplasty

Application of the furlow method to primary velar closure in two-stage palatoplasty

The Goslon yardstick applied to a consecutive series of patients with unilateral clefts of the lip and palate.

First described in 1987, the Goslon yardstick has been used since as a reliable and reproducible means of measuring dental arch relationships and, therefore, the quality of facial growth. The dental study models of a group of 32 consecutively treated patients with unilateral clefts of lip and palate, from the Frenchay Hospital, Bristol, U.K., were analyzed using the Goslon yardstick. More than 50% of the sample were in the unfavorable Goslon groups IV and V. Because of these results, we at Frenchay Hospital now base our related surgical procedures on the early vomerine closure of the anterior hard palate without nasal or alveolar repair at 3 months, followed by primary hard and soft palate closure at 6 months.