Cleft palate repair in a patient with speech defect

Age for Cleft palate surgical repair

Cleft palate surgical repair is usually done at the age of 10 months. This is done at this specific time to prevent the speech difficulties that may develop in the future. However, all the patients who are operated for cleft palate deformity have to undergo a speech assessment after 3years of age and should undergo speech therapy if needed.  Due to the scar contracture of the previous surgeries some patients develop a condition known as velopharyngeal insufficiency. Normally during the speech, the muscles of the soft palate along with lateral and posterior pharyngeal walls create a sphincter-like closure between the oral and nasal cavity to aid in the production of a clear speech. In velopharyngeal insufficiency, there will be shortening of the soft palate muscles due to the scar contracture. Thus a proper sphincter like closure between oral and nasal cavities cannot be created which results in increased escape of air during the speech. This causes a nasal tone to the speech of the affected individual. These patients should undergo another surgery known as Furlow’s double opposing Z- plasty.

In this surgery, the muscles of soft palate are dissected and sutured in both oral and nasal layers such that their arrangement resembles a Z-shape. This surgery creates a sling like an arrangement of the muscles and also causes lengthening of the muscles of the soft palate which helps in creating a proper closure between the oral and nasal cavities. Thus the nasal air escape during speech is reduced resulting in a clear speech. These patients are further aided by speech therapy after surgery to aid them in attaining a clearer speech. All types of cleft lip and palate surgeries, secondary revision surgeries, speech surgeries, speech therapy and the necessary dental treatment for cleft patients are being done at Richardson’s dental & craniofacial hospital by Dr. Sunil Richardson & his team.