Order of Consonant Production as a Predictor of Speech Outcomes After Primary Palatoplasty

Reliable early prediction of long-term speech outcomes after primary palatoplasty has not been explored. This study aimed to (1) clarify the relationship between the pattern of initial consonant production and postoperative speech outcome in patients with cleft palate (CP), and (2) investigate whether differences exist in the order pattern of initial consonant production by CP presence.

Consecutive children who underwent primary CP surgery between 2001 and 2016 at our hospital were retrospectively analyzed; 42 and 38 children were assigned to the CP and non-CP groups, respectively. The production order of the main Japanese consonants/k/,/g/,/t/, and/d/ was analyzed, and 3 groups were created: type td, where t/d precedes k/g; type kg, where k/g precedes t/d; and type same, where t/d and k/g occur simultaneously. We compared consonant patterns between groups and assessed the association between these patterns and the incidence of velopharyngeal insufficiency (VPI), abnormal articulations, and the need for additional treatment in the CP group.

At both 4 and 7 years, the likelihood of having VPI was significantly higher in type kg children than in type td children. Velar consonants did not precede alveolar consonants in the non-CP group. Significantly more type kg patients received additional treatment than type td (P < 0.001) and type same (P = 0.003) groups.

Patients with normal velopharyngeal function acquired alveolar consonants (td) before velar consonants (kd), indicating that those who first produced velar consonants were more likely to present with VPI or require additional treatment.