Normal Speech Should be the Expected Outcome in the Adopted Cleft Child

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Speech Pathology

Background:

• Internationally adopted children with cleft palate often face worse speech outcomes and higher complication rates.
• Accurate counseling for adoptive parents requires understanding outcomes in this specific population.

Purpose of the Study:

• To evaluate speech outcomes and complication rates in internationally adopted children with cleft palate.
• To provide data for improved counseling of adoptive parents regarding cleft palate repair.

Main Methods:

• Review of a consecutive series of 72 internationally adopted children with unrepaired cleft palate.
• Surgical intervention included 2-flap palatoplasty with radical intravelarveloplasty (2003-2015).
• Speech outcomes assessed using Pittsburgh Weighted Speech Score; secondary procedures included fat grafting, intravelarveloplasty, and sphincter pharyngoplasty.

Main Results:

• 43% achieved successful speech initially; 74% achieved normal speech after secondary interventions.
• Higher rates of palatal fistula (9.2%) and velopharyngeal insufficiency (50%) compared to nonadopted populations.
• Secondary surgeries, including minimally invasive options, significantly improved speech scores (P < 0.001).

Conclusions:

• Internationally adopted cleft palate patients exhibit higher complication rates but can achieve successful speech outcomes.
• Minimally invasive secondary procedures are effective in improving speech in this cohort.
• The study highlights the need for specialized care and realistic counseling for adoptive families.