Cause of cleft palate influences velopharyngeal valving during speech
MedWire News: Patients with cleft palate caused by the genetic velocardiofacial syndrome (VCFS) have significantly different velopharyngeal speech impairments to patients with non-syndromic palatal clefts (NSCP), show study findings.
"Several anomalies associated with the palatal cleft in patients with VCFS can explain these differences," say Antonio Ysunza and colleagues from the Hospital GEA Gonzalez in Mexico City, Mexico.
"Thus, the surgical approach for repairing a palatal cleft should consider these differences. Moreover, surgical planning should be performed according to the specific findings of the velopharyngeal sphincter in order to improve speech outcome," they add.
Ysunza and team recruited 20 individuals with VCFS and 20 with NSCP to take part in their study. All the participants had previously undergone palatal repair and speech therapy and were aged 11.3 years on average.
The participants underwent a thorough clinical speech evaluation including videonasopharyngoscopy (VNP) and videofluoroscopy (VF).
The investigators observed significant differences between the VCFS and NSCP groups.
Patients with VCFS had a significantly decreased mean velum (V) and lateral pharyngeal wall (LPW) motion compared with those with NSCP, at 46% versus 71% and 14% versus 30%, respectively.
Furthermore, the size of the velopharyngeal closure gap during speech was significantly increased in patients with VCFS compared with NSCP, at 67.4% versus 34.6%.
Writing in the International Journal of Pediatric Otorhinolaryngology, the team says that the observed dissimilarities may be due to differences in the formation of the palatal cleft between the two patient groups.
Specifically, Ysunza and co-workers found that 17 patients with VCFS had a submucous cleft palate and three had a sub-total cleft of the secondary palate, with similar cleft types in those with NSCP.
In the VCFS group, 14 individuals had a coronal velopharyngeal closure pattern during speech and six a circular pattern.
In contrast, in the NSCP group, 10 patients had a circular velopharyngeal closure pattern, two had a Passavant's ridge, seven had a coronal pattern, and three a saggital pattern.
"Since there are several factors contributing to produce a different velopharyngeal function in patients with VCFS, surgical approach in these cases should be carefully designed, considering these factors and selecting and trying to customize the surgical technique according to the findings of each individual case," conclude Ysunza et al.
By Helen Albert