Sunil Richardson1, Nikkie S Seelan2, Dhivakar Selvaraj3, Rakshit V Khandeparker4, Sangeetha Gnanamony5. 1. Project Director, Dr Jeyashekaran Centre for Cleft Care, Dr Jeyashekaran Hospital, Nagercoil; Director, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India. Electronic address: sunilrichardson145@gmail.com. 2. Speech Language Pathologist, Department of Speech Language Pathology, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India. 3. Professor, Department of Orthodontics, Rajas Dental College and Hospital, Thirunelveli, Tamilnadu, India. 4. Surgical Fellow, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India. 5. Speech Language Pathologist, Department of Speech Language Pathology, Dr Jeyashekaran Hospital, Nagercoil, Tamilnadu, India.
Abstract
PURPOSE: To assess speech outcomes after anterior maxillary distraction (AMD) in patients with cleft-related maxillary hypoplasia. MATERIALS AND METHODS: Fifty-eight patients at least 10 years old with cleft-related maxillary hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant. RESULTS: Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant (P ≤ .001). CONCLUSION: AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment.
PURPOSE: To assess speech outcomes after anterior maxillary distraction (AMD) in patients with cleft-related maxillary hypoplasia. MATERIALS AND METHODS: Fifty-eight patients at least 10 years old with cleft-related maxillary hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant. RESULTS: Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant (P ≤ .001). CONCLUSION:AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment.