Facial grimace during speech in cleft lip and palate: a proposal for classification

Area of Science:

• Speech-language pathology
• Craniofacial anomalies
• Diagnostic methods

Background:

• Velopharyngeal closure (VPC) is crucial for speech intelligibility.
• Assessing VPC can be challenging, especially in individuals with repaired cleft lip and palate.
• Facial grimace (FG) is a potential indicator of velopharyngeal dysfunction (VPD).

Purpose of the Study:

• To evaluate a proposed classification system for facial grimace (FG).
• To determine the correlation between FG ratings and objective velopharyngeal closure (VPC) measurements.
• To assess the reliability of FG as a diagnostic tool for VPD.

Main Methods:

• Twenty individuals with repaired cleft lip and palate participated.
• Velopharyngeal area was measured using rhinomanometry.
• Speech samples were recorded, and facial grimace was rated by speech-language pathologists before and after training.
• Intra- and inter-rater reliability were assessed using weighted Kappa.
• Spearman's correlation coefficient was used to correlate FG ratings with VPC measurements.

Main Results:

• Inter-rater agreement for FG improved from fair/substantial to substantial/almost perfect after training.
• Intra-rater agreement ranged from moderate to almost perfect.
• A significant positive correlation was found between FG ratings and velopharyngeal area in both assessment stages.

Conclusions:

• The proposed FG classification is effective for identifying VPD symptoms.
• The FG rating system demonstrates reliability in diagnosing VPD severity.
• FG shows potential as a reliable perceptual method for predicting VPC, correlating well with instrumental measures.