The relationship between hypernasality and timing of primary palatal surgery and cleft type in 3-6 years old children with cleft palate

Document Type : Original Articles


1 Academic Member, Department of Speech Therapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

2 BSc in Speech and Language Pathology, Isfahan, Iran

3 MSc in statistic, Department of Bio Statistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

4 Academic Member, Department of pediatric surgery, School of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran



Abstract Introduction: There are various types of clefts of the primary and secondary palate and various degrees of severity. Despite the relatively long history of palatal surgery, little consensus has been reached regarding the best surgical techniques, and even less regarding optimal timing. There are still no standard protocols to address the issues of ideal timing for cleft palate repair to attain optimal speech. This study was conducted to examine the frequency of preschoolers with cleft palate who demonstrate hypernasality. The impact of the time of primary palatal surgery and cleft type on moderate to severe hypernasality was also examined. Materials and Methods: A group of 46 preschoolers aged 3-6 years with repaired cleft palate was assessed using Universal Parameters for Reporting Speech Outcomes in Individuals with Cleft Palate – Farsi Edition. Cleft types were bilateral cleft lip and palate (BCLP; n=5, 10/9%), unilateral cleft lip and palate (UCLP; n=20, 43/6%), complete cleft palate (CP; n=10, 21/7%), cleft of the soft palate only (SPO; n=6, 13%) and submucous cleft palate (SubMC; n=5, 10/9%). Judgments of hypernasality were made by a certified speech and language pathologist and were made using a 4-point rating scale. 32 Had a primary palatal surgery prior to 12 months of age, 8 had surgery at 12-18 months of age, and 6 had surgery after 18 months. Results: 78/3 percent of the children demonstrate moderate to severe hypernasality. There were no significant differences between 5 groups for hypernasality based on cleft type. The analysis, also, revealed no significant relationship between age of primary palatal surgery and number of children with significant hypernasality.  Conclusion: Because of the high amount of hypernasality in all children, the need for research documenting the efficacy of surgeries employed with these children is essential. In this study the age range was wide, and there was the small number of children in each cleft palate group. The Additional research is needed to determine if there are variables that might have masked the influence of timing of primary surgery and cleft type( should be deleted). Key words: cleft palate, hypernasality, cleft type, timing of initial (primary)palatal surgery