Social and psychological problems associated with cleft palate.

There are no compelling studies to support the assumption that people with clefts are seriously disturbed or differ in major ways from their noncleft peers. There is evidence to support that both parents and children pay some high prices for the adjustments and accommodations they ultimately make and that clinicians might smooth the way somewhat by becoming more actively aware of the problems that remain to be addressed in treatment programs to the end that the cleft will become a matter of historical significance rather than of current relevance in the life of the adult.

Speech characteristics associated with the Furlow palatoplasty as compared with other surgical techniques.

Reported here are the results of a retrospective study of the speech outcome for 63 cleft subjects who had Furlow repairs compared with 20 subjects who had other procedures. The two groups of children were similar in cleft type, sex, and race. The same two surgeons repaired the palates in both groups, and the same two speech pathologists with high reliability examined the children at least 5 years postoperatively using the Pittsburgh Weighted Values for Speech Symptoms Associated with VPI (velopharyngeal incompetence). Subjects who had had Furlow repairs were superior on measures of hypernasality, articulation, and total speech scores; and fewer pharyngeal flaps were required by Furlow subjects. These findings suggest the need for randomized, double-blind investigations comparing outcome of the Furlow procedure with the intravelar veloplasty, the V-Y pushback, and other specified procedures.

Palatal length in cleft palate as a predictor of speech outcome.

In an attempt to predict which patients might benefit from primary posterior pharyngeal flaps done at the time of palatal repair, palatal length was assessed before palatal repair and the patient was placed in one of four categories. Patients with longer palates preoperatively had statistically better speech outcomes than patients with shorter palates. Statistical significance was found for most speech parameters. Information on presurgical palatal length can be useful in predicting which patients might profit from primary "pharyngoplasties."

A comparative study of four methods of evaluating velopharyngeal adequacy.

Forty-eight subjects with repaired palatal clefts were divided into three major groups on the basis of speech symptoms and were examined for velopharyngeal valving integrity by means of the R-D nasal manometer, pressure-flow techniques, the Hunter oral manometer, and videofluoroscopy. Videofluoroscopy appeared to provide data that most nearly agreed with predictions of valving made from speech. The Hunter oral manometer was the least useful of the four techniques.

Tooth and foreign object in the nasal fossa of a child with a cleft: case report.

A report is presented of a male patient, 5 years, 10 months old, with a palatal cleft complicated by both a tooth and a foreign object in the nasal cavity. The presence of these concurrent conditions contributed to nasal obstruction with associated speech problems, accretions, and chronic rhinorrhea. The importance of a thorough diagnostic work-up and interdisciplinary treatment planning is emphasized.

Submucous clefts of the palate: how likely are they to be symptomatic?

A group of 130 patients with submucous clefts were identified from the records of the University of Pittsburgh Cleft Palate-Craniofacial Center. Many of these patients, 44 percent, remained asymptomatic into adulthood, and none required surgical intervention. A submucous cleft should be repaired in infancy only when feeding problems or unremitting ear disease is observed. The cleft should not be repaired on the theoretical basis of the potential effect of the cleft on the development of communication skills. The development of predictors that will enable professionals' valid management decisions must be developed.

Unresolved issues in velopharyngeal valving.

Although technology for the study and assessment of velopharyngeal function has advanced, we continue to classify that function in simplistic categories: closure, borderline, and no closure. Many questions remain unanswered. Information is needed about the dimensions of closure including depth and orifice configuration as they relate to speech. Under what circumstances does hypernasality involve sound transmission through hypoplastic tissue? Is the configuration of the nasopharynx important to hypernasality? Tension in the speech mechanism and also developmental factors deserve study. Nonsurgical variables that might enhance velopharyngeal function are poorly understood. These and other issues and the means of their investigation are worthy of discussion in our professional forums.

A comparison of intelligence and social maturity in children with unilateral complete clefts and those with isolated cleft palates.

Intelligence and social development were evaluated in 226 subjects with palatal clefts. The subjects were divided into four groups composed of 111 with unilateral complete clefts of the lip and palate (Unilateral Group); 16 with unilateral complete clefts with associated congenital malformations (Unilateral-C Group); 76 with clefts of the palate only (Palatal Group; and 39 with clefts of the palate only with other congenital malformations (Palatal-C Group). Comparisons among groups suggested that subjects in the Unilateral Group were most competent both mentally and socially followed by those in the Palatal, Unilateral-C, and Palatal-C Groups. The presence of congenital abnormalities other than cleft increased the risk of developmental disabilities, particularly in subjects with isolated palatal clefts.

Weight gain in children with cleft palate from birth to two years.

The weights from birth to 2 years of 77 babies with palatal clefts were compared with the weights of normal babies (Pomerance, 1979). Babies with clefts did not differ from normal infants in mean birth weight, but they lagged behind thereafter. Males were more impaired than females.

The use and limitations of the barium pharyngogram in the detection of velopharyngeal insufficiency.

A barium pharyngogram was incorporated into the multiview videofluoroscopic evaluation of the velopharyngeal portal in 195 subjects in order to assess its usefulness in demonstrating competence or incompetence. Reflux of barium was always associated with a velopharyngeal gap and/or hypernasality; however, the absence of reflux was not similarly diagnostic. The pharyngogram proved to be useful in confirming the presence of a palatal or pharyngeal-flap fistula. While it is helpful in assessing velopharyngeal closure in selected cases, it should not be used in the absence of other information.