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Palate Repair Timing Under Age 15 Months and Early Speech Outcomes
Katelyn Kotlarek1, Kazlin Mason2, Amy Davies3
1Division of Communication Disorders, University of Wyoming, Laramie.
Insights
Even slight delays in primary palatoplasty before 15 months may increase the risk of persistent cleft speech characteristics (CSCs) by age 36 months. This highlights the importance of timely surgical intervention for optimal speech development in children with clefts.
Area of Science:
- Craniofacial Surgery
- Pediatric Speech Pathology
- Developmental Pediatrics
Background:
- Early primary palatoplasty is crucial for optimizing speech outcomes in children with cleft palate.
- However, the impact of minor timing variations within the first 15 months on passive cleft speech characteristics (CSCs) remains unclear.
- Passive CSCs can persist post-surgery and affect early speech development.
Purpose of the Study:
- To investigate the association between the timing of primary palatoplasty before 15 months of age and the development of passive CSCs.
- To assess these characteristics at 18-24 months and again at 36 months post-surgery.
Main Methods:
- A longitudinal cohort study design was employed, utilizing data from the Cleft Collective cohort in the UK.
- Participants included children with cleft palate (with or without cleft lip) who underwent primary palatoplasty before 15 months.
- Speech assessments were conducted at 18-24 months and/or 36 months.
Main Results:
- Data from 157 children at 18-24 months and 174 at 36 months were analyzed.
- Passive CSCs were present in 18.5% of children at 18-24 months and 16.7% at 36 months.
- While no association was found at 18-24 months, each additional month delay in palatoplasty at 36 months was linked to increased odds of passive CSCs (OR, 1.24; 95% CI, 1.00-1.54).
Conclusions:
- Later primary palatoplasty, even within the first 15 months, may be associated with a higher likelihood of passive CSCs at 36 months.
- This suggests that even small delays in surgical timing can influence early speech development and velopharyngeal function.
- Optimizing the timing of palatoplasty is critical for mitigating the development of persistent speech issues.
Importance:
Early primary palatoplasty is recommended to optimize speech outcomes, but it is unclear whether small variations in timing within the first 15 months affect the development of passive cleft speech characteristics (CSCs), which can persist despite early repair and impact early speech development.
Objective:
To examine whether differences in timing of primary palatoplasty before age 15 months are associated with development of passive CSCs at age 18 to 24 months and at age 36 months.
Design, Setting, And Participants:
This is a longitudinal cohort study including data from the Cleft Collective, a cohort of children with clefting in the UK recruited from all UK regional cleft centers. Recruitment and data collection began in 2013 and is ongoing. Analysis reported in this study took place on August 14, 2024. Participants were children with cleft palate with or without a cleft lip who had palatoplasty before 15 months and completed speech assessments at 18 to 24 months and/or at 36 months.
Exposures:
Palatoplasty before age 15 months.
Main Outcomes And Measures:
Presence of passive CSCs at 18 to 24 months and at 36 months.
Results:
Speech assessment data were available for 157 children at 18 to 24 months (mean [SD] age at primary palatoplasty, 9.6 [2.3] months; 75 male [47.8%]), of whom 53.5% had cleft palate only, and 174 children at 36 months (mean [SD] age at primary palatoplasty, 9.7 [2.2] months; 90 male [51.7%]), of whom 47.7% had cleft palate only. Palatoplasty technique was available for 105 children at 18 to 24 months and 117 children at 36 months; 94% received an intravelar veloplasty across both samples. Passive CSCs occurred in 18.5% of children aged 18 to 24 months and 16.7% of children aged 36 months. No association was seen at 18 to 24 months; at 36 months, each additional month at repair was associated with increased odds of passive CSCs (odds ratio, 1.24; 95% CI, 1.00-1.54).
Conclusions And Relevance:
Results of this study suggest that even before age 15 months, later palatoplasty may be associated with modest increases in the likelihood of passive CSCs at age 36 months, highlighting the potential role of small delays in early speech and velopharyngeal function.
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