Impact of delayed one-stage palatal closure on speech in Ugandan older children and young adults with cleft (lip and) palate

Introduction: In resource-poor countries, surgeons generally close unrepaired clefts in older children and young adults under the assumption that repair will yield benefit. The purpose of the present study was to assess resonance and articulation characteristics following delayed (≥8y) one-stage palatal closure performed with the Sommerlad technique. Methods: Articulation analyses and perceptual and objective evaluations of resonance were carried out in 15 Ugandan patients with delayed repaired cleft lip and palate (mean age 15y10m) and 15 age- and gender-matched non-cleft control subjects. Results: Postoperatively, nasal emission occurred in 27% of the patients, whereas resonance disorders and articulation errors were prevalent in 87% of the patients. Compared with the control group, significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the patient group. Moreover, significantly smaller consonant inventories and significantly more phonetic articulation disorders were observed. Conclusion: Delayed one-stage palatal repair with the Sommerlad technique (≥8y) seems to be insufficient to eliminate resonance abnormalities, airflow deviation errors and articulation disorders. Consequently, action should be taken to prevent patients’ late presentation at specialized centers in resource-poor countries