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. 2023 May;26(2):297-309.
doi: 10.1111/ocr.12612. Epub 2022 Oct 19.

Surgical sequence, timing and volume, and variation in dento-facial outcome, speech and secondary surgery in children with unilateral cleft lip and palate: The Cleft Care UK Study

Rona Slator  1 , Lydia I Perisanidou  2 , Debbie Sell  3 , Jonathan Sandy  2 , Andrew R Ness  2   4 , Andrew K Wills  2   5
Affiliations

Surgical sequence, timing and volume, and variation in dento-facial outcome, speech and secondary surgery in children with unilateral cleft lip and palate: The Cleft Care UK Study

Rona Slator et al. Orthod Craniofac Res. 2023 May.

Abstract

Objectives: To estimate both the association of surgical variables in complete unilateral cleft lip and palate (cUCLP) in the UK with outcomes at age 5 years, and the association of secondary speech surgery, volume of surgery, and surgeon with the same outcomes.

Setting and sample population: The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with cUCLP.

Materials and methods: Information on surgical variables was extracted from a standardized questionnaire. Dento-facial outcomes were derived from dental study casts of dental arch relationships. Three speech outcomes - intelligibility, structure and articulation - were derived using the Cleft Audit Protocol for Speech-Augmented tool.

Results: Surgical and outcome data were available for 211 (79%) children from all cleft centres in the UK. Later soft palate surgery was associated with a 17% increased chance of a poor intelligibility score (P = .02), and high volume surgery with a 249% increased chance of a good articulation score (P = .01). There were no between surgeon effects identified. No association between the surgical variables examined and dento-facial outcome, or secondary speech surgery by the age of 5 years were found.

Conclusion: This study found associations between surgical variables and speech outcomes at 5 years of age, but not between surgical variables and dento-facial outcome, nor between surgical variables and secondary speech surgery. High surgical volume should be maintained, and any changes towards later surgery monitored for changes in speech outcome.

Keywords: cleft; cleft lip and palate; speech outcomes; surgery.

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References

REFERENCES

    1. Clinical Standards Advisory Group. Cleft Lip and Palate. HMSO; 1998 ISBN 0-11-322103-7.
    1. Sell D, Grunwell P, Mildinhall S, et al. Cleft lip and palate Care in the United Kingdom-the Clinical Standards Advisory Group (CSAG) study. Part 3: speech outcomes. Cleft Palate Craniofac J. 2001;38:30-37.
    1. Al-Ghatam R, Jones TE, Ireland AJ, et al. Structural outcomes in the cleft care UK study. Part 2: dento-facial outcomes. Orthod Craniofac Res. 2015;18:14-24.
    1. Sell D, Mildinhall S, Albery L, Wills AK, Sandy JR, Ness AR. The cleft care UK study. Part 4: perceptual speech outcomes. Orthod Craniofac Res. 2015;18:36-46.
    1. Ness AR, Wills AK, Mahmoud O, et al. Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the cleft care UK study. Part 6: summary and implications. Orthod Craniofac Res. 2017;20:48-51.

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