Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

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DOI

  • Susanna Botticelli
  • Annelise Küseler
  • Kirsten Mølsted, Københavns Universitet, Danmark
  • Helene Soegaard Andersen, Københavns Universitet, Danmark
  • Maria Boers, Københavns Universitet, Danmark
  • Antje Shoeps, Københavns Universitet, Danmark
  • Berit Kildegaard Emborg, Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
  • ,
  • Mia Kisling-Møller, Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark, Danmark
  • Thomas Klit Pedersen
  • Mikael Andersen, Department of Plastic Surgery and Burns Treatment, University Hospital of Copenhagen, Denmark
  • ,
  • Elisabeth Willadsen, Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman =.23; P =.025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P =.004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

OriginalsprogEngelsk
TidsskriftThe Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
Vol/bind57
Nummer4
Sider (fra-til)420-429
Antal sider10
ISSN1055-6656
DOI
StatusUdgivet - apr. 2020

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