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Impact of Quad-Helix Expansion and Bone Grafting on Speech in Children With Unilateral Cleft Lip and Palate
Vikram Shetty1, K M Pratheek2, K J Deepthi3
1Director, Nitte Meenakshi Institute of Craniofacial Surgery and Professor, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral and Maxillofacial Surgery, Mangalore, India.
Background:
Cleft lip and palate (CLP) affect maxillofacial growth, dentoalveolar development, and speech outcomes. Interventions like maxillary arch expansion using a bonded quad-helix (xBQH) and secondary alveolar bone grafting (SABG) are common. Still, their specific impact on speech outcomes, independent of speech therapy, remains underexplored.
Purpose:
The purpose of this study was to measure the association between maxillary arch expansion followed by SABG for oronasal fistula (ONF) closure and speech outcomes among nonsyndromic unilateral CLP (UCLP) patients who didn't receive concurrent speech therapy.
Study Design, Setting, And Sample:
This prospective cohort study was conducted during 2022-2023 at the Nitte Meenakshi Institute of Craniofacial Surgery, Mangalore. Nonsyndromic UCLP patients aged 6 to 10 years were evaluated, and patients with auditory/intellectual impairment and orthodontic appliances covering the palate were excluded. All underwent 6 months of xBQH, followed by 3-month retention and subsequent SABG.
Predictor Variable:
The predictor variable was time, assessed at baseline and at 1 month after SABG.
Main Outcome Variables:
The outcome variable was speech quality (hypernasality, nasal air emission, hyponasality, voice disorders, speech acceptability, and speech understandability) measured using the Henningsson et al universal reporting parameters for cleft palate speech.
Covariates:
The covariates were age and sex.
Analyses:
Dependent speech outcome measures were analyzed using McNemar's test for dichotomous paired data and McNemar-Bowker's test for ordinal paired data. Inter-rater reliability was evaluated using Cohen's kappa coefficient. A two-tailed P value of <0.05 was considered statistically significant.
Results:
The sample comprised 60 subjects with a mean age of 8.63 years (SD = 1.80), 28 (47%) male and 32 (53%) female. Nasal air emission decreased from 20 of 60 (33.3%) at baseline to 5 of 60 (8.3%) post-treatment (P < .01). Speech understandability improved in 21 of 60 (35%) with initially mild impairment and 9 of 60 (15%) with moderate impairment (P < .01). Speech acceptability improved in 20 of 60 (33.3%) with mildly unacceptable speech and in 5 of 60 (8.3%) with moderately unacceptable speech (P < .01). Hypernasality decreased from 10 of 60 (16.7%) to 5 of 60 (8.3%), but the change was not statistically significant (P = .06). No changes were observed in hyponasality or voice disorders.
Conclusion And Relevance:
Maxillary expansion using a xBQH appliance followed by SABG reduced NAE and improved speech understandability and acceptability in children with UCLP, even without speech therapy. These findings support early orthodontic-surgical protocols in cleft care.
