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Delayed primary palatal closure in resource-poor countries : speech results in Ugandan older children and young adults with cleft (lip and) palate

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Abstract
Aims: Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (>= 8 years) primary palatal closure. Methods: Fifteen Ugandan participants with cleft (lip and) palate (CP +/- L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. Results: Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP +/- L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. Conclusions: Delayed palatal repair (>= 8 years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.
Keywords
Cleft palate, Delayed one-stage palatal closure, Resource-poor countries, Sommerlad technique, Speech, NASALANCE SCORES, INTRAVELAR VELOPLASTY, REPAIR, LANGUAGE, GENDER, AGE, TRANSCRIPTION, ARTICULATION, PALATOPLASTY, METHODOLOGY

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Chicago
Bruneel, Laura, Anke Luyten, Kim Bettens, Evelien D’haeseleer, Cleo Dhondt, Andrew Hodges, George Galiwango, Hubert Vermeersch, and Kristiane Van Lierde. 2017. “Delayed Primary Palatal Closure in Resource-poor Countries : Speech Results in Ugandan Older Children and Young Adults with Cleft (lip and) Palate.” Journal of Communication Disorders 69: 1–14.
APA
Bruneel, L., Luyten, A., Bettens, K., D’haeseleer, E., Dhondt, C., Hodges, A., Galiwango, G., et al. (2017). Delayed primary palatal closure in resource-poor countries : speech results in Ugandan older children and young adults with cleft (lip and) palate. JOURNAL OF COMMUNICATION DISORDERS, 69, 1–14.
Vancouver
1.
Bruneel L, Luyten A, Bettens K, D’haeseleer E, Dhondt C, Hodges A, et al. Delayed primary palatal closure in resource-poor countries : speech results in Ugandan older children and young adults with cleft (lip and) palate. JOURNAL OF COMMUNICATION DISORDERS. 2017;69:1–14.
MLA
Bruneel, Laura, Anke Luyten, Kim Bettens, et al. “Delayed Primary Palatal Closure in Resource-poor Countries : Speech Results in Ugandan Older Children and Young Adults with Cleft (lip and) Palate.” JOURNAL OF COMMUNICATION DISORDERS 69 (2017): 1–14. Print.
@article{8528476,
  abstract     = {Aims: Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed ({\textrangle}= 8 years) primary palatal closure. 
Methods: Fifteen Ugandan participants with cleft (lip and) palate (CP +/- L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. 
Results: Nasal emission occurred postoperatively in only 27\% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87\% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP +/- L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. 
Conclusions: Delayed palatal repair ({\textrangle}= 8 years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.},
  author       = {Bruneel, Laura and Luyten, Anke and Bettens, Kim and D'haeseleer, Evelien and Dhondt, Cleo and Hodges, Andrew and Galiwango, George and Vermeersch, Hubert and Van Lierde, Kristiane},
  issn         = {0021-9924},
  journal      = {JOURNAL OF COMMUNICATION DISORDERS},
  language     = {eng},
  pages        = {1--14},
  title        = {Delayed primary palatal closure in resource-poor countries : speech results in Ugandan older children and young adults with cleft (lip and) palate},
  url          = {http://dx.doi.org/10.1016/j.jcomdis.2017.06.010},
  volume       = {69},
  year         = {2017},
}

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