A New Trial Guidance for Speech Therapy for Subjects with Cleft Palate Based on Analysis of the Behaviors of Velopharyngeal Incompetence

Assessment of velopharyngeal closure function (VPF) is most important in planning speech therapy for patients with cleft palate, however, the level of VPF after palatoplasty does not necessarily concur with the consistent results of the speech condition. In this study, the VPF of patients with cleft palate was evaluated for three speech conditions: blowing, phonating consonant and vowels. Furthermore, the characteristics of velopharyngeal incompetence (VPI) and the response to speech therapy were discussed.<BR>Materials The subjects were 42 patients who had received palatoplasty at the average age of 22 months and speech therapy in the Department of Oral and Maxillofacial Surgery, Kyushu University Hospital. Their cleft types were unilateral cleft lip and palate in 19 patients, bilateral cleft lip and palate in 11 submucous cleft palate in 7 and isolated cleft palate in 5.<BR>Methods Their outcomes of speech treatment were evaluated at 4 to 6 years of age. The VPF values were classified into four groups according to the nasal air leakage in the mirror test in three speech conditions. Group one (G1) showed good VPF in all the speech conditions, group two (G2) showed VPI only when phonating vowels, group three (G3) showed VPI when phonating both consonants and vowels, and group four (G4) showed VPI in all the speech conditions. The VPF was compared among the four groups regarding the blowing ratio, nasalance score by the Nasometertest, and both velopharyngeal morphology and movement of the soft palate from cephalometric analysis.<BR>Results Twenty-three patients were classified as Gl,6 as G2,7 as G3, and 6 as G4. Cephalometric analysis revealed that the soft palate was long and showed good mobility in Gl. In G2, the mobility of the soft palate was poor. In G3, the soft palate was short but the mobility was good. In G4, the soft palate was short and the mobility was poor.<BR>Conclusion Evaluating the velopharyngeal closure function under various speech conditions is useful for comprehending the symptoms and planning treatment. Our guidance of speech therapy for postoperative VPI using the mirror test is that G2, which is characterized as poor movement of the soft palate, needs facilitation of mobility; G3 with a short palate needs prosthodontic treatment, if necessary, followed by surgical approaches to lengthen the soft palate, and G4 with poor mobility of the short soft palate needs secondary palatoplasty.