Major Research Findings

Cleft palate is a birth defect that occurs when the roof of the mouth does not close completely during pregnancy. This can cause a range of problems, including speech difficulties, hearing loss, and feeding problems. 7 found that children with cleft palate have smaller air-containing spaces in their middle ears, and this difference increases with age. They also found that the rate of recurrent otitis media with effusion (OME) after ear tube removal is higher in children who have their ear tubes placed earlier. Additionally, children with earlier tube placement showed delayed temporal bone development.

8 studied adults with cleft palate who received interdisciplinary care at the Ghent University Hospital. They found that these individuals showed improvements in their speech and health-related quality of life (HRQoL) outcomes. Interdisciplinary care, which involves a team of specialists, can offer comprehensive support for individuals with cleft palate, addressing their physical, functional, and psychosocial needs.

9 investigated the effectiveness of a new electropalatography (EPG) therapy, based on usage-based phonology theory, in improving the accuracy of speech sounds for children and adults with persistent speech sound disorder (SSD) secondary to cleft palate. This study suggested that EPG therapy might be a promising tool for enhancing speech accuracy in individuals with cleft palate who experience difficulties with certain sounds.

10 reviewed the current literature on surgical treatment for cleft palate in dogs. While oronasal fistula formation (a connection between the nasal and oral cavities) is a common complication, the review concluded that surgery can result in good to excellent outcomes for dogs when carefully planned and executed. Surgical intervention is essential to separate the nasal/nasopharyngeal and oral/oropharyngeal passages, allowing dogs to eat and breathe normally without food or other foreign materials entering the respiratory tract.

11 highlighted a case of neglected cleft palate in a 13-year-old girl discovered during a screening campaign at a hospital in the Central African Republic. This case serves as a reminder of the importance of early diagnosis and treatment of cleft palate, particularly in resource-limited settings.

12 examined the impact of rurality on the caseloads and treatment decisions of speech-language pathologists (SLPs) who work with children with cleft lip and/or palate. The study found that SLPs in rural areas often have higher caseloads and face challenges in accessing specialized resources compared to their urban counterparts, leading to potential disparities in care.

13 investigated the outcomes of the Furlow double-opposing Z-plasty, a surgical technique used to repair symptomatic submucous cleft palate. This technique is a preferred method in Helsinki’s cleft center and demonstrated promising results in treating this specific type of cleft palate.

14 performed a systematic review of the literature on surgical treatment for velopharyngeal dysfunction (VPD) in patients with cleft palate, aiming to develop a treatment algorithm. This review categorized surgical techniques into palatal and pharyngeal surgeries, analyzing speech outcomes and complication rates. While success and complication rates were similar across techniques, the review identified key factors influencing treatment choice, such as VP gap size, LVP position, palatal mobility, and age.

15 determined the prevalence of early childhood caries (ECC) treatment using general anesthesia (GA) in children with cleft lip and/or palate in Manitoba. The study found that a significant portion of children with cleft lip and/or palate required GA for ECC treatment, emphasizing the importance of preventive dental care for this population.

16 provided a comprehensive tutorial for speech-language pathology assistants (SLPAs) regarding treatment techniques and principles for children with cleft palate. This tutorial aims to equip SLPAs with the necessary knowledge and skills to effectively support children with cleft palate in their speech development.

17 presented a protocol for a comparative effectiveness study investigating the outcomes of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI). This study aims to provide evidence-based insights into the best surgical approach for correcting VPI in patients who have undergone previous cleft palate repair.

18 conducted an umbrella review of velopharyngeal insufficiency (VPI) treatments in cleft lip and palate patients, evaluating effectiveness based on existing systematic reviews. The review found that surgical intervention is often necessary in symptomatic patients, and while no single surgical technique emerged as the gold standard, the Furlow Z-plasty and minimal incision palatopharyngoplasty were highlighted as promising approaches.

19 proposed a treatment algorithm for secondary VPI, using Furlow palatoplasty or posterior pharyngeal flap (PPF) to balance speaking and breathing. The study identified age and preoperative velopharyngeal closure ratio as crucial factors in determining the best surgical approach, suggesting that Furlow palatoplasty might be preferred for younger patients with a higher closure ratio.

4 explored the use of electropalatography (EPG) in speech therapy for individuals with articulation disorders associated with cleft palate. This study suggested that EPG can be a valuable tool for addressing persistent articulation difficulties that don’t respond to standard treatment approaches.

5 systematically reviewed the long-term craniofacial morphology in young adults treated for non-syndromic UCLP (unilateral cleft lip and palate). While the review found no significant impact of early vs. late palate closure on maxillary growth, it emphasized the need for high-quality research to guide evidence-based decision-making regarding surgical timing.

2 compared two surgical methods for palatal closure in patients with submucous cleft palate: minimal incision palatopharyngoplasty and a combination of minimal incision palatopharyngoplasty with individualized velopharyngeal surgery. The study concluded that minimal incision palatopharyngoplasty is a safe and reliable approach, with the addition of individualized surgery not showing a significant benefit in reducing the frequency or size of residual velopharyngeal insufficiency.

6 evaluated the need for maxillary osteotomy after cleft palate surgery, comparing the rate of osteotomies in a retrospective study with data extracted from a systematic review. The study found a lower rate of maxillary osteotomies than reported in the literature, suggesting potential improvements in treatment strategies.

1 confirmed the invariable presence of otitis media with effusion (OME) in children with cleft palate aged 2 to 20 months, emphasizing the importance of early diagnosis and treatment. The study stressed the need for close collaboration between otologists and plastic surgeons to manage these children’s ear health.

3 evaluated the impact of infant orthopaedics (IO) on maxillary arch dimensions in infants with unilateral cleft lip and palate. This randomized controlled trial found that IO had only a temporary effect on maxillary dimensions, suggesting that its use as a tool to improve maxillary arch form could be abandoned. However, further research is needed to assess the comprehensive effect of IO, including other outcome variables like facial and dental appearance.

treatment まとめ

7 focused on measuring the volume of air-containing space in children with cleft palate and assessing its relationship with age, ear tube placement, and temporal bone development. They found that smaller air-containing spaces and delayed temporal bone development were associated with earlier tube placement. This study highlights the importance of addressing middle ear issues in children with cleft palate.

8 explored the benefits of interdisciplinary care for adults with cleft palate, demonstrating that comprehensive care addressing their speech, HRQoL, and other needs can lead to positive outcomes. This research emphasizes the importance of a multidisciplinary approach in managing cleft palate.

9 investigated a new EPG therapy based on usage-based phonology theory for improving speech accuracy in children and adults with cleft palate. This study suggested that EPG therapy could be a valuable tool for enhancing speech production in individuals with cleft palate.

10 summarized the current literature on cleft palate surgery in dogs, highlighting the importance of careful planning and execution to minimize complications such as oronasal fistulae. This review provides valuable insights for veterinary professionals working with dogs with cleft palate.

11 presented a case study of neglected cleft palate in a 13-year-old girl in the Central African Republic. This case highlights the importance of early diagnosis and treatment for individuals with cleft palate.

12 investigated the challenges faced by SLPs in providing care for children with cleft palate in rural areas. This study emphasized the importance of addressing resource disparities and ensuring equitable access to care for individuals with cleft palate.

13 studied the effectiveness of the Furlow double-opposing Z-plasty in repairing symptomatic submucous cleft palate, suggesting that this technique is a promising approach for this specific type of cleft palate.

14 aimed to develop a treatment algorithm for velopharyngeal dysfunction in patients with cleft palate, identifying key factors that influence the choice of surgical technique. This review contributes to the development of evidence-based treatment plans for individuals with cleft palate.

15 investigated the prevalence of early childhood caries (ECC) treatment using general anesthesia in children with cleft lip and/or palate. This study highlights the need for preventative dental care to minimize the need for invasive treatment under general anesthesia.

16 provided a comprehensive tutorial for SLPAs on treating speech sound errors in children with cleft palate. This tutorial emphasizes the importance of specialized training for professionals working with this population.

17 described a protocol for a comparative effectiveness study examining the outcomes of revision palatoplasty versus pharyngoplasty for velopharyngeal insufficiency. This research aims to provide evidence-based insights into the best surgical approach for addressing this condition.

18 conducted an umbrella review of velopharyngeal insufficiency treatments, identifying the Furlow Z-plasty and minimal incision palatopharyngoplasty as promising approaches for correcting this condition. The review highlighted the need for high-quality research to establish the gold standard treatment for VPI.

19 proposed a treatment algorithm for secondary VPI, emphasizing the importance of considering age and preoperative velopharyngeal closure ratio in choosing between Furlow palatoplasty and posterior pharyngeal flap.

4 explored the use of EPG in speech therapy for individuals with cleft palate, suggesting its potential for addressing persistent articulation difficulties.

5 reviewed the long-term craniofacial morphology in young adults treated for non-syndromic UCLP. While the review did not find a significant impact of early vs. late palate closure on maxillary growth, it highlighted the need for robust research to guide treatment decisions.

2 compared two surgical techniques for palatal closure in patients with submucous cleft palate, finding that minimal incision palatopharyngoplasty is a safe and reliable approach.

6 assessed the need for maxillary osteotomy after cleft palate surgery, suggesting potential improvements in treatment strategies that may reduce the need for this procedure.

1 highlighted the high prevalence of OME in children with cleft palate, emphasizing the importance of early diagnosis and collaboration between otologists and plastic surgeons.

3 evaluated the impact of infant orthopaedics (IO) on maxillary arch dimensions, suggesting that IO may not be necessary as a tool to improve maxillary arch form.

Benefits and Risks

Benefits Summary

Treatment for cleft palate can significantly improve speech, hearing, breathing, and feeding difficulties experienced by individuals with this condition. 8 found that interdisciplinary care can improve speech and health-related quality of life (HRQoL) in adults with cleft palate. 9 suggested that a new EPG therapy could improve speech accuracy for those with cleft palate. These findings highlight the potential for treatment to enhance the lives of individuals with cleft palate.

Risks Summary

Treatment for cleft palate, particularly surgical procedures, carries certain risks. 7 found that early ear tube placement in children with cleft palate can lead to a higher rate of recurrent otitis media with effusion and delayed temporal bone development. 10 reported that oronasal fistula formation is a common complication of cleft palate surgery in dogs. These findings underscore the importance of carefully considering the risks and benefits of treatment and discussing them with healthcare providers.

Comparison between Studies

Commonalities between Studies

Many of these studies indicate that treatment for cleft palate can significantly improve the lives of affected individuals. However, the studies also highlight that the type of treatment, the timing of interventions, and the specific needs of each individual play crucial roles in determining the effectiveness and potential risks associated with treatment.

Differences between Studies

Some studies focused on specific aspects of cleft palate treatment, such as the impact of rurality on access to care ( 12 ), the effectiveness of specific surgical techniques ( 13 , 14 , 18 ), or the prevalence of certain complications like otitis media ( 7 , 1 ). This variation in focus reflects the multi-faceted nature of cleft palate and the need for research to address different aspects of treatment.

Consistency and Contradictions in Findings

While many studies suggest that treatment for cleft palate can significantly improve quality of life, they also indicate that the effectiveness and risks of treatment vary depending on the specific condition, the chosen approach, and the individual’s needs. Some studies highlighted the challenges of ensuring equitable access to care for individuals with cleft palate, particularly in rural areas. These contradictions highlight the need for further research to refine treatment strategies and address disparities in care.

Real-World Application Considerations

The research findings indicate that treatment for cleft palate can significantly improve the lives of individuals with this condition. However, it’s essential to remember that the effectiveness and potential risks of treatment vary depending on the specific condition, the chosen approach, and the individual’s needs. It’s crucial to have open and honest conversations with healthcare providers about the benefits and risks of treatment, and to consider the potential for disparities in access to care.

Limitations of Current Research

Some limitations exist in the current research on cleft palate treatment. Many studies had relatively small sample sizes, potentially limiting the generalizability of their findings. Additionally, some studies did not follow participants over long periods, making it difficult to assess the long-term effects of treatment. Further research is needed to address these limitations.

Directions for Future Research

Future research on cleft palate should focus on addressing the limitations of previous studies. This includes conducting larger-scale studies with longer follow-up periods to better understand the long-term effects of treatment. Researchers should also prioritize investigating disparities in access to care and exploring innovative treatment approaches to ensure equitable outcomes for all individuals with cleft palate.

Conclusion

Treatment for cleft palate offers significant benefits, including improved speech, hearing, breathing, and feeding. However, it’s crucial to acknowledge the variability in effectiveness and potential risks associated with different treatment approaches. This highlights the need for careful consideration of each individual’s needs, open communication with healthcare providers, and ongoing research to improve treatment outcomes and ensure equitable access to care for all individuals with cleft palate.

Treatment List

Electropalatography (EPG) therapy, Furlow double-opposing Z-plasty, minimal incision palatopharyngoplasty, revision palatoplasty, pharyngoplasty, posterior pharyngeal flap, surgery, speech therapy, interdisciplinary care, infant orthopaedics