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Early Palate Repair Is Associated With Improved Self-perceived Speech In Long-term Outcomes For 157 Patients
Kirin Naidu, MPhil1, Santiago Lopez-Becerra, BS
1, Alvin Yu, BS
1, David Perrault, MD
1, Nicholas A. Han, BSE
2, Maura R. Guyler, BA
1, Joseph A. Napoli, MD DDS
1, David D. Low, MD
1, Eric C. Liao, MD PhD
1, Oksana A. Jackson, MD
1, Scott P. Bartlett, MD
1, Jesse A. Taylor, MD
1, Jordan W. Swanson, MD MSc
1.
1Children's Hospital of Philadelphia, Philadelphia, PA, USA,
2University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
PURPOSE: To examine how timing of palate repair and secondary cleft-related surgery affect long-term patient- and clinician-reported speech outcomes.
METHODS: A total of 157 patients who underwent palate repair were analyzed using date-matched CLEFT-Q Speech Function (CQSF), Speech Distress (CQSD), and Pittsburgh Weighted Speech Scale (PWSS) scores. Linear regression, Wilcoxon tests, and Spearman correlations evaluated effects of repair timing and secondary procedures.
RESULTS: Mean age at repair was 10.7 months, with 10.4 years of follow-up. Each month of delay beyond 12 months corresponded to progressively lower CQSF scores (p < 0.001). Patients repaired at 9-11 months had higher CQSF scores than those repaired at 13-15 months (82.8 vs 69.7, p = 0.034), a difference that was both statistically and clinically significant. Earlier repair independently predicted better CLEFT-Q scores (p < 0.001), while PWSS remained unaffected (p > 0.8).Fifty-two patients underwent secondary procedures: VPI repair (n = 7), fistula repair (n = 14), alveolar bone graft (n = 8), rhinoplasty (n = 6), and others (n = 17). Across procedures, PWSS changed minimally (-0.6), while CQSF (+5.6) and CQSD (+3.5) improved. VPI repair yielded the largest PWSS gain (-7.14, p = 0.016). After ABG, PWSS was unchanged (p = 0.83) but CQSF trended upward (+8.2, p = 0.10), reflecting perceived improvement without objective change
CONCLUSION: Palate repair at 9-11 months yields superior long-term, self-perceived speech outcomes. Among secondary procedures, VPI repair improved both clinician- and patient-rated speech, whereas ABG primarily enhanced perceived speech quality.
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