Search

The assessment of rehabilitation outcomes requires a patient documentation protocol, including records obtained at standardized ages, to compare different types of surgeries, their effects, as well as between different rehabilitation centers. The aim of this paper was to present proper trays for babies with different types of cleft lip and palate, which are used in the outpatient routine at Hospital of Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). The customized trays are made with self-curing acrylic resin. The tray must have suitable depth to copy the buccal sulcus, and wax is usually applied to contour the tray edge, and the adjustment of the tray to the fornix, making the tray specific for each child. The impression precludes the utilization of dental casts for diagnosis, treatment plan, and research measurements. In the clinical practice at HRAC-USP, it was observed that customized trays increased the quality of impression, accurately reproducing anatomical features of dental arches of babies with oral clefts.

Objectives: The aim of this study was to assess the survival rate of dental implants inserted in an alveolar cleft area where one or more bone graft procedures were performed and to identify possible factors that affect the survival rate., Materials and Methods: The available data from 78 implants placed in 64 patients with grafted alveolar clefts were retrospectively analysed. Statistical analyses were performed using Kaplan-Meier survival analysis, log-rank tests and univariable Cox proportional hazard models., Results: The median follow-up period from insertion to the last follow-up appointment was 46 months (IQR: 29-79.3). In five patients, a single implant failed. This resulted in a cumulative survival rate of 95.0% at median follow-up. The factors investigated in this study did not have a significant effect on implant survival., Conclusions: Dental implants placed in patients with alveolar clefts are a reliable treatment option for dental rehabilitation., (© 2023 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

It is assumed that most cleft lip and palate are due to a combination of genetic and environmental factors (maternal diseases, smoking, alcohol intake, infections, and ionizing treatment) that alter morphogenesis. Treatment of these cases begins from birth to adulthood and requires a number of interventions depending on the period of development of the maxillofacial area and teeth.We present the case of a patient with unilateral cleft lip and palate. Surgery and orthodontic treatment were carried out subsequently, and then a metal-ceramic bridge was made to correct the defect. In the course of the treatment, we made decisions that were determined by the available space.The construction restored the dentition, the aesthetics, speech, and masticatory functions of the patient. The treatment of such defects requires good collaboration between individual specialists in order to achieve optimally good results. We believe that in such cases of crucial importance is the contribution of a prosthetic dentistry expert since surgical and orthodontic treatments alone are insufficient to achieve complete recovery and rehabilitation of patients., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We aimed to evaluate the treatment protocols for cleft lip and palate that are used in Brazil, to compare them with the ones proposed from elsewhere, and to discuss the official data about admission for treatment of cleft lip or palate, or both, in Brazil. We also assessed the importance of integrated action of different specialities to treat this condition. A questionnaire related to attendance protocols was developed and sent out to all Brazilian Plastic Surgery Services connected to the Brazilian Society of Plastic Surgery, and to other units involved in such treatment. We also studied the data produced by the Brazilian Department of Health about the operations done during the past five years. Many protocols were identified, but despite much controversy in many areas, a consensus was reached about the surgical techniques, the age group most suitable to be operated on, and there was total agreement about the need for multidisciplinary management. According to the State Department of Health, the number of operations done in 1995 was 9696, and this had increased to 21 022 in 1999. The state of São Paulo had done 17 636 (84%) of all procedures in 1999. [ABSTRACT FROM AUTHOR]

A 49-year-old male patient with residual cleft palate and missing pre-maxilla presented with an ill-fitting and unaesthetic maxillary denture. The posterior teeth were periodontally sound but crowded and had defective restorations and secondary caries. We restored the bilateral maxillary canines and first premolars with conical telescopic crowns having magnetic keepers. A metal-reinforced acrylic overdenture with magnetic attachments corresponding to the keepers of the telescopic crowns was fabricated. The telescopic crowns provided a single path of insertion, retention and stability to the prosthesis. The magnetic attachments provided additional retention and self-centring properties. The prosthesis effectively sealed the oronasal communication and enhanced the function, aesthetics and oral hygiene. The 6-month and 1-year follow-ups revealed that the patient was delighted, and the prosthesis provided excellent obturation and function. Periodic follow-up, maintenance, patient education and meticulous oral hygiene are vital for long-term success of such prostheses., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose of Review: Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate., Recent Findings: The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics., Summary: According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.

In this study, we investigated brain morphological changes in adults with non-syndromic cleft lip and palate (NSCLP) after articulation rehabilitation (AR). High-resolution T1 weighted brain magnetic resonance imaging data were analyzed from 45 adults with NSCLP after palatoplasty: 24 subjects were assessed before AR (bNSCLP) and 21 subjects were assessed after AR (aNSCLP). In addition, there were 24 age and sex matched controls. Intergroup differences of grey matter volume were evaluated as a comprehensive measure of the cortex; cortical thickness and cortical complexity (gyrification and fractal dimensions) were also analyzed. As compared to controls, the bNSCLP subjects exhibited altered indexes in frontal, temporal, and parietal lobes; these morphological changes are characteristic for adults with NSCLP. Importantly, as compared to the bNSCLP and control subjects, the aNSCLP subjects exhibited cortical plasticity in the regions involved in language, auditory, pronunciation planning, and execution functions. The AR-mediated cortical plasticity in aNSCLP subjects may be caused by AR-induced cortical neurogenesis, which might reflect the underlying neural mechanism during AR.

Objectives: workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP ± L)., Methods: The participants who presented during the two-day course were asked to complete a pre- and post-workshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP ± L and to assess the changes in their self-confidence in the diagnosis and treatment of this population., Results: seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP ± L and their self-confidence in the diagnosis and treatment of children with a CP ± L significantly higher than before the workshop., Conclusion: the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP ± L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/aims: In resource-limited countries, traditional models for speech therapy delivery are not adequate to reach all patients in need. In those countries, intensive speech therapy might be a solution. Preliminary results of previous research demonstrated that intensive speech therapy can be effective in the short term for patients living in countries with limited access to speech therapy. Questions might arise whether or not intensive treatment results in long-term benefits for these patients. Hence, the present study investigated long-term effectiveness of intensive speech therapy provided to Ugandan patients born with a cleft palate with or without cleft lip (CP ± L) in terms of different speech characteristics., Methods: Five Ugandan patients with CP ± L, who received intensive speech therapy in the past, were contacted to participate in this follow-up study. All patients agreed to participate. Perceptual and instrumental speech evaluations were performed identically to the assessments immediately before and after speech therapy, to allow for comparison. Additionally, the Cleft Evaluation Profile, investigating self-perceived satisfaction with cleft-related features was included to compare satisfaction before and after speech therapy., Results: Long-term improvement in percentage correct consonants was seen in four patients. Furthermore, after speech therapy, decreased presence of resonance disorders was observed in two of the included patients. Before speech therapy, all participants were dissatisfied with speech. Interestingly, after intensive speech therapy, satisfaction with speech was seen in every patient and this satisfaction remained in the long term., Conclusion: In summary, speech improvements after speech therapy varied among the five patients. Nevertheless, present study provided encouraging results to further investigate effectiveness of intensive speech therapy in patients with CP ± L., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports. The patients were followed up for at least 1 year. Adoption of the proposed guidelines enables satisfactory esthetic and functional outcomes in patients with cleft lip and palate., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Objective: To analyze the training technique, intervention timing, and other related factors involved in the speech therapy delivered to cleft patients with velopharyngeal competence after surgery., Methods: A retrospective study was conducted on 32 patients who received phonology-articulation speech therapies during 2012 to 2013 in Dept. of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University. All patients achieved normal speech one year after therapy. Information collected included the types and number of consonant articulation error, the overall period of training, the interval between surgery and speech training, and the age during speech training. Statistical analyses were performed in SPSS 16.0., Results: Ten patients received less than five sessions of training, seventeen received six to ten sessions, and five received eleven to twenty sessions. The number of sessions was positively correlated with the number of errors (r(s)=0.394, P=0.026). On the average, each additional error cost another 0.570 session for correction (confidence interval: 0.137-1.004). Moreover, the number of sessions was negatively correlated with age (P=0.055). Patients between 5 to 10 years old took significantly lesser sessions than those above 10 years. No correlation was found between the number of sessions and the interval between surgeries and trainings., Conclusions: Appropriate speech therapy efficiently rehabilitate the speech condition of cleft patients with velopharyngeal sufficiency after surgery. The number of errors is directly proportional to the number of sessions needed. Patients above 10 years require more sessions than those less than 10 years.

Objective: To investigate the early reading abilities, and related cognitive-linguistic processes, in bilingual children with nonsyndromic cleft lip and/or palate (CL/P), and to identify deficits that might be amenable to intervention., Design and Participants: Bilingual participants with CL/P aged 5 to 6 years who were English-dominant ( n=17) or Mandarin-dominant ( n=18) were recruited using consecutive sampling from a national cleft treatment center and matched pairwise to a sample of typically developing (TD) children on language dominance, age, and socioeconomic status. All participants were assessed in English on single-word reading accuracy using the Wide Range Achievement Test (4th Ed), and key cognitive-linguistic factors associated with reading development: phonological awareness, rapid automatized naming (RAN), receptive and expressive vocabulary, and verbal short-term and working memory., Results: CL/P and TD groups were compared within language dominance group (Mandarin or English) for all measures. The Mandarin-dominant CL/P group had significantly poorer reading accuracy and phonological awareness than their TD peers. Additionally, regardless of language dominance, faster RAN correlated significantly with better reading accuracy in both the CL/P groups but not the TD groups., Conclusions: Children with CL/P who are learning English as a second language are at greater risk of reading difficulties. Furthermore, the cognitive-linguistic processes underlying early reading in bilingual children with CL/P differ from those of their TD peers. Routine screening and tailored intervention is advisable.

Congenital malformations of the maxillofacial area - congenital cleft lip and palate (CCLP) due to their frequency, the severity of anatomical and functional disorders, the difficulty of social adaptation of patients, economic aspects are one of the most important problems of medicine. It is established that for timely stage surgical treatment of children with IAPC the emphasis is on the somatic status of the child, anti-infective resistance, the ability to safely tolerate surgery, which is important for the restoration of anatomical defects, communication functions and psychosomatic health. Children with CCLP are at risk for increased occurrence of postoperative complications, since upper respiratory tract infection and exacerbation of chronic respiratory tract diseases and ENT organs is a contraindication to surgical intervention. The study of immune status revealed deep violations of antiviral and antibacterial immunity in children with CCPC aged from 6 to 12 years. A program of combine interferon- and immunotherapy has been created. Positive clinical and immunological efficacy of combine interferon-(gel Viferon - recombinant IFNα2b in combination with antioxidant) and immunotherapy in the rehabilitation of children with CCPC aged 6 to 12 years was demonstrated.

Objective: To assess the orthodontic burden of care of patients from a Brazilian rehabilitation center (Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo [HRAC-USP])., Design: Retrospective., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo., Interventions: One hundred files of unilateral complete cleft lip and palate patients who had consecutively finished orthodontic rehabilitation at HRAC-USP were evaluated from January 2011 to January 2013. The duration of orthodontic treatment, number of visits, kilometers traveled, number of appliances and surgical procedures performed were recorded. The sample was divided into 2 subgroups according to severity the interarch relation (Goslon Yardstick score) at the beginning of orthodontic treatment. Mann-Whitney test was applied for intergroup comparison ( P < .05)., Results: For the total sample (n = 100), the mean time of orthodontic treatment was 140.2 months, the mean number of orthodontic appointments was 61.8, the mean number of appliances was 10, the mean number of surgical procedures was 6.2, and the mean distance traveled to attend the center for orthodontic appointments was 38,978.5 km. The subgroup with the most severe malocclusion (Goslon yardsticks scores 4 and 5) showed a longer orthodontic treatment length, greater number of surgical procedures, and longer distance traveled than those presenting Goslon yardstick scores 1, 2, and 3., Conclusion: Patients with greater severity of the initial malocclusion experienced a higher burden of care than patients with less severity of the initial malocclusion. To reduce the burden of care, research and efforts should focus on minimizing maxillary growth deficiency related to primary surgery.

Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

Background: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence., Subjects and Methods: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava., Results: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function., Conclusion: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.

Purpose: The purpose of this pilot study was to investigate the extent to which a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT+ PE), improved the language and speech outcomes of toddlers with cleft lip and/or palate (CL/P)., Method: Nineteen children between 15 and 36 months (M = 25 months) with nonsyndromic CL/P and typical cognitive development were randomly assigned to a treatment (EMT+PE) or nontreatment, business-as-usual (BAU), experimental condition. Participants in the treatment group received forty-eight 30-min sessions, biweekly during a 6-month period. Treatment was delivered in a university clinic by trained speech language pathologists; fidelity of treatment was high across participants., Results: Children in the treatment group had significantly better receptive language scores and a larger percentage of consonants correct than children in the BAU group at the end of intervention. Children in the treatment group made greater gains than children in the BAU group on most language measures; however, only receptive language, expressive vocabulary (per parent report), and consonants correct were significant., Conclusions: The results of this preliminary study indicate that EMT+PE is a promising early intervention for young children with CL/P. Replication with a larger sample and long-term follow-up measures are needed.

This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student's ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey's test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. P<0.05 was considered statistically significant. Decreased intercanine distance and anterior arch length were observed after lip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

The objective of this study was to investigate the prevalence of live births with orofacial clefts in Brazil from 2009 to 2013, according to Brazil's federative units and regions, and correlate it with the number of corrective surgery procedures for cleft lip and palate performed through the Brazilian National Health System in the same period. The data were collected from the National Live Birth System (SINASC in Portuguese) and the Hospital Information System (SIH-SUS in Portuguese). The results showed that the average prevalence of oral clefts in the period was 5.86 per 10,000 live births, with differences observed between the federative units and the regions. The correlation between the prevalence of orofacial clefts and the number of medical procedures associated with this anomaly was statistically significant (r=0.94; p <0.001). This result indicates that greater investments are being made in areas with a higher number of cases. The relationship between supply and demand for corrective surgeries suggests that only 18.91% of the live births with orofacial clefts in this period may have received this service under the Brazilian National Health System.

Purpose: To investigate the influence of speech sample of spontaneous conversation or sentences repetition on intra and inter-rater hypernasality reliability., Methods: One hundred and twenty audio recorded speech samples (60 containing spontaneous conversation and 60 containing repeated sentences) of individuals with repaired cleft palate±lip, both genders, aged between 6 and 52 years old (mean=21±10) were selected and edited. Three experienced speech and language pathologists rated hypernasality according to their own criteria using 4-point scale: 1=absence of hypernasality, 2=mild hypernasality, 3=moderate hypernasality and 4=severe hypernasality, first in spontaneous speech samples and 30 days after, in sentences repetition samples. Intra- and inter-rater agreements were calculated for both speech samples and were statistically compared by the Z test at a significance level of 5%., Results: Comparison of intra-rater agreements between both speech samples showed an increase of the coefficients obtained in the analysis of sentences repetition compared to those obtained in spontaneous conversation. Comparison between inter-rater agreement showed no significant difference among the three raters for the two speech samples., Conclusion: Sentences repetition improved intra-raters reliability of perceptual judgment of hypernasality. However, the speech sample had no influence on reliability among different raters.

Objective: The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics., Methods: Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed., Results: Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention., Conclusion: This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

This paper relates, through a clinical case, the different steps of the prosthodontic rehabilitation of a palate-pharyngeal cleft, sequelae to surgery, by performing a Suersen’s Velar obturator since the soft Palate is divided but toned. A functional reeducation in conjunction with a prosthodontic care improves the quality of life’s patients and help for their resocialization. This therapeutic is non-invasive, quick, efficient and evolutive method.

Objective: The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected., Setting: The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, Germany, Patients and Participants: Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped., Results: Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons' attitudes., Conclusion: Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.

Abstract Retrospective analysis was conducted in 78 patients of various age, who suffered the inborn lip and palate fissura, for estimation of the patients quality of life after uranostaphiloplasty. The operations were performed on clinical base of The Oral Cavity Surgery and The Jaw-Facial Surgery Cathedra in Department of The Jaw-Facial Surgery of Clinical Medical Center (Baku). There was established, that application of uranostaphiloplasty procedure, as well as timely initiated rehabilitation, influences a further establishment of the patient personality. A timely refer to a speech therapeutist and the treatment began also have great significance for further establishment of the patient personality. Disorders of speech, incorrect bite hampers obtaining of education, working, interferes with a family creation, hampers the employment and worsens a quality of life.

Objective: Mini dental implants could be an alternative treatment method for prosthetic treatment of edentulous cleft palate. The aim of this study was to analyze stress distribution around the cortical bone and different plans using a varied number of mini dental implants in edentulous unilateral complete cleft palates., Materials and Methods: Three edentulous maxillary models were modified to create unilateral complete cleft palates. Mini dental implants (2.4 × 15 mm) were located as two mini implants at the premolar region, four mini implants at the premolar and molar region, and six mini implants at the first premolar, second premolar, and first molar regions in the models, respectively. Mucosa, o-ring/ball attachments, and overdentures were simulated. Vertical and horizontal loads of 100 N were applied on both the right and left molar teeth of the overdenture for each model. Maximum and minimum principal stress values and the distribution at cortical bone around the implants and cleft palates were evaluated by finite element analysis., Results: Stress values under vertical loads were lower than values under horizontal loadings for all models. Stress values were found to be lower in the first model than in the second and third models. The highest stress values were found around implants in the second model. The unilateral feature of a complete cleft pattern affected the stress distribution., Conclusion: Stresses occured mostly around implants when the overdenture was supported by six implants; however, the stress distribution around implants was low with two implants because of tissue support.

Passively retained precision attachment removable partial dentures have been used successfully since the 1920s. Adult cleft palate patients and accident victims often have endured a lifetime of wearing awkward appliances to replace the missing structures that never formed intraorally or were lost in a traumatic accident. These patients tend to be poor candidates for dental implants, even with repeated grafting surgeries. The anterior double-tilt precision attachment case is a great treatment option for adults to restore the missing dental structures. Anterior precision partial dentures are stable appliances in the mouth that are worn 24 hours a day and only removed for hygiene. They can be custom designed for maximum esthetics. They do not require denture paste, and they extend minimally onto the palate. As a result, they do not interfere with musculature, tongue movements, speech and taste. Cleft palate patients and accident victims with poor or non-existent edentulous ridges will have difficulty retaining a denture, so preservation of the existing dentition is essential for comfort and function. Because these prostheses do not apply destructive forces to the abutment teeth, they can last decades with minimal maintenance.

Introduction: Mentoring programs can boost Speech & Language (SL) pathologists' satisfaction about their clinical skills, increasing their professional competence. A quality induction program provides a bridge for an efficient and comfortable transition between theoretical knowledge and clinical practice in front of clients. This transition can be especially difficult when the SL pathologist confronts patients with cleft palate., Objective: To study whether a mentoring program can improve SL Pathology students' performance for treating patients with cleft palate., Materials and Methods: 18 SL Pathology students coursing the third year of a SL Pathology graduate program volunteered for participating in the study. The students were divided in two groups. All SL students from both groups were equally supervised. The students were followed for two semesters during their participation in the SL Pathology intervention for patients with cleft palate. The only difference between the students from each group was that one group (active group) was mentored by an experienced SLP who had previously received specific training to become a mentor. All SL students were assessed at the onset and at the end of the study. The assessment was performed through an analysis according to a previously validated scale (Learning Continuum of Speech & Language pathologists)., Results: A Wilcoxon test demonstrated a significant improvement (P<0.05) in the levels of The Learning Continuum of Speech & Language Pathologists at the end of the follow-up period in both groups of students. When the levels of performance at the end were compared between groups, a Mann Whitney test demonstrated a significant difference (P<0.05). The students included in the active group who were receiving additional mentoring besides the usual clinical supervision, showed a greater improvement as compared with the students from the control group., Conclusions: Learning how to conduct an adequate and effective intervention in cleft palate patients from an integral stand point is not easy for SL students. The support and guidance of an experienced mentor seems to enhance self-confidence and improve students' performance confronting patients with cleft palate., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department., Material and Methods: Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined., Results: A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results., Discussion: Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: Evaluate the speech services using a Community-Based Speech Therapy model by trained speech assistants (SAs) on the improvement of articulation in cleft palate children., Material and Method: Seventeen children with repaired cleft palates who lived in Chiang Rai and Phayao provinces were registered to the camp. They received speech therapy with a 4-day intensive camp and five follow-up camps at Chiang Rai's The Young Men's Christian Association (YMCA). Eight speech assistants (SAs) were trained to correct articulation errors with specific modeling by the speech-language pathologists (SLPs). SAs encouraged family members to stimulate their children every day with speech exercise at home. Each camp was covered with a main speech therapy and others supported by the multidisciplinary team, as well as, discussion among SLPs, SAs and the care givers for feedback or difficulties., Results: Results showed a sufficient method for treating persistent speech disorders associated with cleft palate. Perceptual analyses presented significant improvement of misarticulation sounds both word and sentence levels after speech camp (mean difference = 1.5, 95% confidence interval = 0.5-2.5, p-value <0.01; mean difference = 2.5, 95% confidence interval = 1-3, p-value <0.001, respectively)., Conclusion: The Community-Based Speech Therapy model is a valid and efficient method for providing speech therapy in cleft palate children.

Background: Most children with cleft lip and palate have articulation problems because of compensatory articulation disorders from velopharyngeal insufficiency. Theoretically, children should receive speech therapy from a speech and language pathologist (SLP) 1-2 sessions per week. For developing countries, particularly Thailand, most of them cannot reach standard speech services because of limitation of speech services and SLP Networking of a Community-Based Speech Model might be an appropriate way to solve this problem., Objective: To study the effectiveness of a networking of Khon Kaen University (KKU) Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham, in decreasing the number of articulation errors for children with CLP., Material and Method: Six children with cleft lip and palate (CLP) who lived in Borabue and the surrounding district, Maha Sarakham, and had medical records in Srinagarind Hospital. They were assessed for pre- and post-articulation errors and provided speech therapy by SLP via teaching on service for speech assistant (SA). Then, children with CLP received speech correction (SC) by SA based on assignment and caregivers practiced home program for a year., Results: Networking of Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham significantly reduce the number of post-articulation errors for 3 children with CLP. There were factors affecting the results in treatment of other children as follows: delayed speech and language development, hypernaslaity, and consistency of SC at local hospital and home., Conclusion: A networking of KKU Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, and Maha Sarakham was a good way to enhance speech therapy in Thailand or other developing countries, where have limitation of speech services or lack of professionals.

Background: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment., Objective: To examine the impact of the empowering volunteer project, established in the northeast Thailand., Material and Method: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed., Results: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers., Conclusions: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Background: Prevalence of cleft lip and palate (CLP) is high in Northeast Thailand. Most children with CLP face many problems, particularly compensatory articulation disorders (CAD) beyond surgery while speech services and the number of speech and language pathologists (SLPs) are limited., Objective: To determine the effectiveness of networking of Khon Kaen University (KKU) Community-Based Speech Therapy Model: Kosumphisai Hospital, Kosumphisai District and Maha Sarakham Hospital, Mueang District, Maha Sarakham Province for reduction of the number of articulations errors for children with CLP., Material and Method: Eleven children with CLP were recruited in 3 1-year projects of KKU Community-Based Speech Therapy Model. Articulation tests were formally assessed by qualified language pathologists (SLPs) for baseline and post treatment outcomes. Teachings on services for speech assistants (SAs) were conducted by SLPs. Assigned speech correction (SC) was performed by SAs at home and at local hospitals. Caregivers also gave SC at home 3-4 days a week., Results: Networking of Community-Based Speech Therapy Model signficantly reduced the number of articulation errors for children with CLP in both word and sentence levels (mean difference = 6.91, 95% confidence interval = 4.15-9.67; mean difference = 5.36, 95% confidence interval = 2.99-7.73, respectively)., Conclusion: Networking by Kosumphisai and Maha Sarakham of KKU Community-Based Speech Therapy Model was a valid and efficient method for providing speech services for children with cleft palate and could be extended to any area in Thailand and other developing countries, where have similar contexts.

A 26-year-old woman was referred to a periodontal surgical practice for concerns related to gingival recession. After several consultations among the orthodontist, periodontist, and cosmetic/restorative dentist, she decided to have surgically facilitated orthodontic therapy as part of a collaborative, interdisciplinary treatment planning process to correct her constricted maxillary arch form, augment thin dentoalveolar facial bone, simultaneously with gaining root coverage as well as improving attached gingiva width and mucogingival thickness. As a consequence of changing the arch form, an improvement in the buccal corridor space was gained which optimized her smile display., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: The management of cleft lip, alveolar and palate sequelae remains problematic today. To optimize it, we tried to establish a new clinical index for diagnostic and prognostic purposes., Technical Note: Seven tissue indicators, that we consider to be important in the management of alveolar sequelae, are listed by assigning them individual scores. The final score, obtained by adding together the individual scores, can take a low, high or maximum value., Discussion: We propose a new classification (ACS: Alveolar Cleft Score) that guides the therapeutic team to a prognosis approach, in terms of the recommended surgical and prosthetic reconstruction, the type of medical care required, and the preventive and supportive therapy to establish. Current studies are often only based on a standard radiological evaluation of the alveolar bone height at the cleft site. However, the gingival, the osseous and the cellular areas bordering the alveolar cleft sequelae induce many clinical parameters, which should be reflected in the morphological diagnosis, to better direct the surgical indications and the future prosthetic requirements, and to best maintain successful long term aesthetic and functional results., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Cleft palate defect with complete edentulism in elderly patients presents a prosthodontic challenge for complete denture fabrication. Such large defects are very difficult to restore by surgical intervention and have direct consequence on such functions as mastication and speech, on aesthetics, and on the patient's mental attitude. This article describes a case report in which a 76-year-old female patient underwent restoration with a closed hollow bulb obturator for a large cleft palate defect.

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Oral rehabilitation of adult patients with cleft lip and palate is related to the severity of the anatomical and functional alterations that hamper the proper closure of the nasopharynx. The ideal treatment is closure by bone graft and orthodontics. However, when surgery is not possible or when the patient does not wish to undergo surgery, a palatal prosthesis may offer the best solution in most clinical situations. The authors of this article propose a new classification to help the practitioner with decision making and prosthetic treatment planning for residual palatoalveolar cleft defects.

Purpose: This study obtained nasalance scores during use of compensatory articulation (CA) and compared nasalance between groups with and without hypernasality and with and without CA., Methods: Speech samples were obtained from 43 individuals with and without velopharyngeal dysfunction during repetition of 20 phrases originating 860 audio recordings and their respective nasometric values. After excluding 143 recordings due to low quality, the remaining 717 samples were rated by three speech language pathologists (SLPs), independently, for presence or absence of hypernasality and CA. Nasalance scores for the 553 samples rated with 100% agreement among the SLPs were grouped according to the auditory-perceptual ratings: Group 1 (G1) - included samples without hypernasality and without CA (n=191); Group2 (G2) - included samples with hypernasality and without CA (n=288); Group 3 (G3) - included samples with hypernasality and with pharyngeal fricative (n=33); Group 4 (G4) - included samples with hypernasality and with glottal stop (n=41)., Results: Analysis of variance (ANOVA) revealed significant difference nasalance scores which were significantly higher for G2, G3, and G4 (p<0.0001) when compared to G1. The use of pharyngeal fricative (G3), particularly during /f/ (p=0.0018) and /s/ (p=0.0017) productions resulted in nasalance scores significantly higher than scores found for G2., Conclusion: Significantly higher nasalance values where identified during use of pharyngeal fricative.

Traumatic injuries or congenital malformations may cause soft and hard tissue defects resulting in the loss of alveolar bone and attached mucosa. Restoring the defective area presents a challenge for clinicians. The prosthetic rehabilitation of 2 patients with maxillary dentoalveolar defects with 2 different prosthetic designs is presented. The esthetic and functional requirements of the patients were fulfilled., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Recent advances in surgery and orthodontics have resulted in improvements in the management of patients with a cleft lip or palate. Early surgical intervention and bone-grafting procedures have frequently been used to ensure closure of the cleft and continuity of the alveolar bone. However, a need for the prosthodontic management of patients with a cleft palate still exists. Most frequently, the indication is to restore the edentulous spaces located anteriorly in the vicinity of the residual cleft defect. In addition to improving the esthetic outcome, prosthodontic management also is required to restore function, especially occlusion and speech. This clinical report illustrates the management of an adult patient with a unilateral cleft of the lip and palate who required prosthodontic rehabilitation after surgery. The patient had previously undergone multiple surgeries and did not want to consider implant therapy as a treatment option. Thus, the patient was managed with fixed and removable prosthodontics with a maxillary overdenture prosthesis retained by microextracoronal resilient attachments, which were laser welded onto crowns on abutment teeth to obtain a functionally and esthetically acceptable result., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Microsurgical nerve lengthening was performed in two siblings presenting a popliteal pterigium syndrome with a knee flexion contracture of 80 degrees. After the first attempt for nerve lengthening and knee extension elsewhere, a repeated lengthening was required due to continuing tip-toe walking and recurrent knee contracture at the age of 3 years. An extensive external and internal interfascicular microsurgical neurolysis resulted in a lengthening of the nerves. A full length of leg procedure had to be performed, inclusive of Achilles tendon lengthening to obtain a complete extension of the knee and a 90-degree ankle flexion. Maintaining the leg in a fully extended position was obtained with a dynamic splinting in the first month after the operation. When timing the operation we have to consider the importance of adequate precision of the microsurgical neurolysis, down to the identification of the Fontana bands, and the adequate postoperative splinting., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Speech errors associated with cleft palate are well established for English and several other Indo-European languages. Few articles describing the speech of Putonghua (standard Mandarin Chinese) speakers with cleft palate have been published in English language journals. Although methodological guidelines have been published for the perceptual speech evaluation of individuals with cleft palate, there has been no critical review of methodological issues in studies of Putonghua speakers with cleft palate. A literature search was conducted to identify relevant studies published over the past 30 years in Chinese language journals. Only studies incorporating perceptual analysis of speech were included. Thirty-seven articles which met inclusion criteria were analyzed and coded on a number of methodological variables. Reliability was established by having all variables recoded for all studies. This critical review identified many methodological issues. These design flaws make it difficult to draw reliable conclusions about characteristic speech errors in this group of speakers. Specific recommendations are made to improve the reliability and validity of future studies, as well to facilitate cross-center comparisons.

Cleft palate is a congenital disorder characterized by maxillary growth defect and dental anomalies. Its correction requires an interdisciplinary approach, which includes surgical, orthodontic, and prosthetic treatments. This clinical report describes the prosthetic management of a 19-year-old woman with a unilateral cleft palate defect that had not been closed completely with surgical repair. The deficient maxillary residual anterior ridge was restored with a tooth-supported overdenture that improved her facial appearance, speech, and masticatory functions., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background: Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted., Aims: To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years., Methods & Procedures: Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months., Outcomes & Results: PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group., Conclusions & Implications: As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate., (© 2013 Royal College of Speech and Language Therapists.)

Purpose: To assess the effects of speech therapy on the acoustic characteristics of speech in a group of cleft lip and palate patients., Materials and Methods: In this experimental pilot study, eight patients with unilateral cleft lip and palate participated in the 13-month period of speech therapy. They had some exercises in the class and at home to reduce the hypernasality of speech. Using an acoustic software named Praat, three formants (F1, F2, F3) of speech sounds /b /, /p /, /f /, /v /, /k /, and /g / were obtained pre and post speech therapy. We used paired samples t-test to compare the acoustic variables of each consonant before and after the therapy., Results: No significant differences were found between the pre- and posttherapy acoustic measures for fricative consonants /f /, /v / and stop consonants /k / and /g/. However, a statistically significant improvement in hypernasality of labial consonants /b / and /p / was observed after the speech therapy., Conclusions: The present study underlines the role of a speech therapist in a complete cleft care team, in order to take care of the speech improvement of the patient and to motivate the parents to help the speech development of their child., (© 2013 Special Care Dentistry Association and Wiley Periodicals, Inc.)