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Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia
Sunil Richardson1, Nikkie S Seelan2, Dhivakar Selvaraj3
1Project Director, Dr Jeyashekaran Centre for Cleft Care, Dr Jeyashekaran Hospital, Nagercoil; Director, Richardson's Dental and Craniofacial Hospital, Nagercoil, Tamilnadu, India.
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.
