Speech outcome evaluation in post-cleft palate closure patients with two flaps pushback technique

Irma Kusumawati (Program Study of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java)
Andri Hardianto (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java)
Agus Nurwiadh (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Padjadjaran, Bandung, West Java)

Majalah Kedokteran Gigi Indonesia
Vol 8, No 2 (2022): August

Speech quality is an essential output in assessing the success of a palatoplasty. The goal of a palatoplasty is not merely to create a simple anatomical closure of the palate, but also to create an adequate velopharyngeal mechanism for a normal speech outcome and to prevent abnormal maxillofacial development after surgery. The aim of this study is to find out the difference in speech outcome between post-cleft palate closure patients and patients without cleft palate. An analytical retrospective study was conducted on 22 children (n = 22) with complete unilateral cleft palate, who had been treated using two flap push back technic of palatoplasty during 2014-2017 by purposive sampling method, and 22 children without cleft palate as the control group. The evaluation of speech outcome was done using an assessment of perception by doing a speech pathologist and instrumental examination by taking a lateral cephalometry radiograph. The perception was assessed by the articulation pattern, hypernasality, and speech intelligibility. The lateral cephalometry radiograph was taken at /i/ phonation to measure the distance velum to the posterior pharynx wall. Data were analyzed using Mann Whitney test. The velopharyngeal competence in post-palatoplasty group consisted of 22.8% adequate result, 0.1% marginal result, and 68.1% inadequate result. Meanwhile, in the control group, there were 72.7% adequate and 27.3% inadequate competence. According to the result of the statistical test, this study concluded that there was a significant difference in speech outcome based on articulation pattern, hypernasality, speech intelligibility, and velopharyngeal distance between post-cleft palate closure patients and patients without cleft palate (p < 0.05). Majority of patients after cleft palate closure with two flaps pushback technique had inadequate velopharyngeal competence with moderate-severe hypernasality, severe nasal emission, abnormal speech intelligibility, and velopharyngeal distance ≥ 5.0 mm, whereas the majority of control group had an adequate velopharyngeal competence.