Speech in Sri Lankan cleft palate subjects with delayed palatoplasty.

This investigation was undertaken within the context of the Sri Lankan Cleft Up and Palate Project, probably the largest surgical and research programme to date concerned with the late operated cleft lip and/or palate subject (Mars et al., 1990). This study examines the speech results of88 patients who received palatal surgery by a visiting British surgical team. The main cohort, consisting of 67 nonsyndromic cleft lip and/or palate Sinh ala speaking patients over the age of eight years at palate repair, have been studied longitudinally. All these patients have pre-operative, post-operative, and post-therapy speech recordings. In addition, 21 similar patients below the age of eight years at surgery have been partially examined. 51 patients have further speech recordings at 4 or 5 years post-operatively. Investigations of velopharyngeal function were undertaken using lateral skull X-rays of patients phonating "ee', nasopharyngoscopy, and a perceptual assessment. Post-operative intra-oral examinations were also carried out. A unique method of speech analysis has been devised, and is used to describe the speech results. The results have shown that patients who have established their speech with an unrepaired palate usually have severely disordered speech, with the exception of some patients with less severe clefts. Post-operatively, many patients retain these poor speech patterns, even with some speech therapy support. Post-therapy, only one third of the cohort had normal or near-normal speech, none of whom were adults. The value of palatal closure is very limited if regular speech therapy is not available as a follow-up to surgery. Only 20% of the cohort achieved post-operative velopharyngeal closure, suggesting that palatoplasty is an inadequate surgical procedure for the majority of patients, in particular those who present with major clefts and are older than eight years of age at surgery. The important variables affecting outcome are palatal repair, speech therapy intervention, age, cleft type, nature of pre-operative speech, and nature of surgery. Structural factors in particular velopharyngeal function and also possibly fistulae, in the adult group, are further relevant variables. Criteria for selecting patients for surgery within this type of environment are proposed.