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Title: The effect of maxillary advancement on speech, nasality and velopharyngeal function in cleft lip and palate
Author: Pereira, V. J.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2012
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10-50% of individuals with cleft lip and palate (CLP) may undergo maxillary osteotomy in adolescence. The surgery can impact on speech including articulation, resonance and velopharyngeal function. A systematic review of the literature using levels of evidence and power calculations was undertaken. This showed that the evidence base at present for CLP is weak or non-existent due to poor speech and study methodology. The aims of the PhD were to examine the impact of the surgery on speech and to identify valid predictors of acquired velopharyngeal deterioration post-operatively. The prospective study recruited a consecutive series of CLP patients undergoing maxillary osteotomy within the North Thames Regional Cleft Service (UK) and two control groups: a non-CLP group undergoing the surgery and normal controls. CLP patients were seen for perceptual speech assessments, speech acoustics, nasometry, lateral videofluoroscopy, nasendoscopy and pressure-flow. The data were analyzed using perceptual clinical ratings and/or specialized computer software. Reliability studies for all outcomes were undertaken. Statistical analyses using SPSS included within- and between-subject analyses of variance, planned comparisons to look at differences across time points, and correlational analyses. Several multiple regression models were tested to identify valid predictors of acquired velopharyngeal deterioration. The main findings of the study indicate that maxillary osteotomy affects CLP and non-CLP patients differently. In CLP, the surgery has a positive impact on articulation but affects resonance and velopharyngeal function negatively. Although /s/ improves, it is not normalized even a year post-operatively. Results also indicate that resonance changes at 3-months post-operatively appear to be permanent. Initial multiple regression analyses identified pre-operative closure ratio and proportion of palate contacting the posterior pharyngeal wall as valid predictors of hypernasality at 12-months post-operatively. A speech care pathway for patients with cleft lip and palate undergoing advancement surgery, encompassing key elements of assessment, review and management, is proposed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available