Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors

作者：Willadsen Elisabeth^*; Lohmander Anette; Persson Christina; Lundeborg Inger; Alaluusua Suvi; Aukner Ragnhild; Bau Anja; Boers Maria; Bowden Melanie; Davies Julie; Emborg Berit; Havstam Christina; Hayden Christine; Henningsson Gunilla; Holmefjord Anders; Holtta Elina; Kisling Moller Mia; Kjoll Lillian; Lundberg Maria; McAleer Eilish; Nyberg Jill; Paaso Marjukka; Pedersen Nina Helen; Rasmussen Therese; Reisaeter Sigvor; Andersen Helene Sogaard; Schops Antje

来源：Journal of Plastic Surgery and Hand Surgery, 2017, 51(1): 38-51.

DOI：10.1080/2000656X.2016.1254647

• Primary palatal repair
• unilateral cleft lip and palate
• consonant proficiency
• cleft speech characteristics
• randomised clinical trial

Background and aim: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy.
Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Norway, Sweden, and the UK.
Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments.
Results: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p=.045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p=.01).
Conclusions: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

• 出版日期2017