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Long-term speech outcomes following functional palatal repair
Anika S Szwedyc1,2, Suvi A Alaluusua1,2, Ville P Kinnula1,2
1Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland.
Objective:
To evaluate long-term functional outcomes following palatal surgery as velopharyngeal dimensions evolve in growing children with cleft palate (CP).
Summary Background Data:
Functional palatal repair using the Furlow method effectively corrects speech symptoms related to velopharyngeal insufficiency (VPI) in patients with CP. However, existing studies have focused on short-term follow-up.
Methods:
This retrospective study analyzed data from 5384 participants with CP, including 92 who underwent functional palatal repair to correct speech symptoms related to VPI and were followed up until adulthood. A speech pathologist evaluated perceived velopharyngeal competence (VPC) preoperatively, postoperatively, and at long-term follow-up. Follow-up visits were scheduled at 8, 10, 12, 14, 16, and 18 years, with assessments extending up to 12 years post-surgery. We compared postoperative velopharyngeal function (VPF) at each time point.
Results:
A general linear mixed model and Wilcoxon signed-rank test showed no significant differences in VPF between ages 8 and 14 years. Comparison of postoperative evaluations after functional palatal repair indicated that adequate VPF was maintained in 88, 84, 82, 78, 77, and 76% at the 8-, 10-, 12-, 14-, 16-, and 18-year time points, respectively. Statistically significant negative VPF changes were observed between the 16- and 18-year time points, suggesting a progressive increase in the likelihood of VPC deterioration.
Conclusion:
Longitudinal follow-up after functional palatal repair showed that VPF remained adequate during growth in most patients with CP. However, during growth, some developed VPI, with a statistically significant negative change observed between 16 and 18 years of age.