Assessing the impact of palatal fistula formation and cleft width on speech outcomes following double opposing Z-plasty in patients with cleft palate.

OBJECTIVE: This retrospective study investigated the influence of palatal fistula (PF) formation after double opposing Z-plasty (DOZ) on speech outcomes in patients with cleft palate (CP), focusing on cleft width and palatal length as predictors of velopharyngeal insufficiency (VPI). METHODS: This study included 1117 patients with CP (579 males, 538 females) who underwent DOZ, performed by a single surgeon, between 1988 and 2017. Demographic characteristics, cleft dimensions, history of PF formation, and speech outcomes were investigated. Speech evaluations were performed at a minimum age of five to assess nasal emission, hypernasality, compensatory articulation, intelligibility, necessity for VPI surgery, and speech therapy. Logistic regression analysis was performed. RESULTS: Speech assessments were conducted at the median age of five (interquartile range [IQR], 5-6 years). Overall, 96.5% of patients achieved 'socially acceptable speech' after DOZ. Patients with PF history showed greater cleft width and experienced higher rates of hypernasality, nasal emission, and VPI on videofluoroscopy (VFS) compared to those without PF history (mean, 11.4 mm vs. 7.1 mm; 28.4% vs. 23.6%; 34.8% vs. 14.9%, 38.5% vs. 14.0%, 40.6% vs. 28.3%, respectively; all p < 0.0001). Cleft width was significantly associated with VPI-related speech outcomes in the multivariate logistic regression analysis, affecting both perceptual and VFS-measured outcomes. CONCLUSIONS: A wider CP gap significantly increased the risk of VPI-related speech difficulties after DOZ. Cleft width is a more critical predictor of adverse speech outcomes than the presence of small-to-medium-sized PFs. Patients with a history of PF and wider cleft gaps require targeted interventions and intensified follow-up to effectively manage and improve speech outcomes.

Catch-Up Growth Pattern in Cleft Palate: A Longitudinal Study from Infancy to Adolescence.

OBJECTIVE: To characterize the patterns of somatic catch-up growth from infancy to adolescence in patients with cleft palate (CP). STUDY DESIGN: We assessed 474 nonsyndromic patients with isolated cleft palate (n = 69) and unilateral and bilateral cleft lip and palate (n = 271; n = 134) who underwent palatoplasty between 1988 and 2017 and had longitudinal physical growth data at birth (T0), cheiloplasty (T1), palatoplasty (T2), childhood (T3), and adolescence (T4). The z scores of weight (ZWT), height (ZHT), and body mass index (ZBMI) were compared among the CP types (isolated cleft palate, unilateral cleft lip and palate, and bilateral cleft lip and palate) and time points (T1, T2, T3, and T4). Subgroup analyses were performed to investigate the growth of patients with malnourishment (z score < -1) at T1 or T2. A generalized linear model was used to investigate the effects of gestational age and cardiac anomalies on the longitudinal changes in ZHT and ZBMI. RESULTS: Regardless of the time point, the overall ZHT, ZWT, and ZBMI approximated 0 in all CP types, indicating few differences from the mean values of noncleft children. Significant catch-up growth occurred in ZHT and ZWT from T1 to T4 for all CP types (all P < .05). Despite the recovery of ZHT and ZBMI in most patients with malnourishment, these values remain relatively low until adolescence. Patients who were born at preterm stage or had surgically repaired cardiac anomalies grew well. CONCLUSIONS: Even in infants with CP and malnutrition, preterm birth, or cardiac anomalies, rapid catch-up growth can occur prior to palatoplasty with the help of comprehensive cleft care.

Long-term effects of lateral nasal wall anchored facemasks compared with tooth-borne facemasks.

INTRODUCTION: This study investigated the long-term effect and stability of skeletally anchored facemasks (SAFMs) with lateral nasal wall anchorage compared with conventional tooth-borne facemasks (TBFMs) in growing patients with a Class III relationship. METHODS: A total of 180 subjects treated with SAFMs (n = 66) and TBFMs (n = 114) were screened. Thirty-four subjects were qualified and grouped into the SAFM group (n = 17) and TBFM group (n = 17). Lateral cephalograms were taken at the initial observation, after the protraction, and at the final observation. RESULTS: Greater advancement of the maxilla was attained with SAFM than with TBFM after protraction (initial observation - after the protraction) (P <0.05). In particular, advancement of the midfacial area (SN-Or) was prominent and maintained after the postpubertal stage (P <0.05). The intermaxillary relationship was also improved (ANB, AB-MP) (P <0.05), and greater counterclockwise rotation of the palatal plane (FH-PP) was observed in the SAFM group compared with the TBFM group (P <0.05). CONCLUSIONS: Compared with TBFM, the orthopedic effects of SAFM were greater in the midfacial area. The palatal plane had a greater counterclockwise rotation in the SAFM group than in the TBFM group. Maxilla (SN-Or), intermaxillary relationship (APDI), and palatal plane angle (FH-PP) demonstrated a significant difference between the 2 groups after the postpubertal stage.