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Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol
1Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Insights
Early palate closure using the Sommerlad protocol resulted in excellent speech and velopharyngeal function (VPF) outcomes by age 5. This technique demonstrated reduced need for speech therapy and secondary surgeries for cleft palate patients.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Speech Pathology
Background:
- Velopharyngeal dysfunction (VPD) and speech impediments are common challenges following cleft palate repair.
- The Sommerlad protocol for palate closure aims to optimize speech outcomes through early intervention and specific surgical techniques.
Purpose of the Study:
- To evaluate speech and velopharyngeal function (VPF) outcomes at age 5 in children who underwent early complete palate closure using the Sommerlad protocol.
- To analyze surgical characteristics associated with these outcomes.
Main Methods:
- A retrospective, descriptive, cross-sectional study of 391 patients who underwent palate repair between 1993 and 2006.
- Surgical intervention involved lip and vomerine flap repair (3 months) and palate closure (mean 6.6 months) using radical muscle dissection and retropositioning.
- Speech and VPF outcomes were assessed using the Cleft Audit Protocol for Speech-Augmented (CAPS-A), yielding Velopharyngeal Composite (VPC) and articulation scores.
Main Results:
- 97% of patients achieved adequate VPF (VPC-SUM CAPS-A score of 0).
- 73% had no cleft articulation difficulties; bilateral cleft lip and palate (BCLP) group showed poorer articulation.
- Low rates of secondary speech surgery (2.6%) and fistula repair (10.7%) were observed. Levator muscle quality and retropositioning correlated with VPF outcomes.
Conclusions:
- Complete palate closure around 6 months via the Sommerlad technique yields excellent VPF and speech outcomes at age 5.
- This approach appears to require less speech therapy and fewer secondary surgeries compared to other reported methods.
- The study establishes the Sommerlad protocol as a benchmark for achieving superior speech results in cleft palate patients.
Objective:
To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol.
Design:
A retrospective, descriptive, cross-sectional consecutive series.
Setting:
A regional twin site center; a district general hospital and tertiary children's hospital.
Participants:
Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate.
Intervention:
Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad.
Outcome Measures:
Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented.
Results:
A VPC-SUM CAPS-A score of "0" was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI.
Conclusions:
Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
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