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Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis

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Abstract

Objectives

In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome.

Materials and methods

A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model.

Results

One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15–24), after Z-palatoplasty 6% (95% CI 4–9), and after palatoplasty with buccal flaps 7% (95% CI 4–11).

Conclusions

A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair.

Clinical relevance

Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality.

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Authors and Affiliations

  1. Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands

    Lieke Hofman, Joris A. van Dongen, Aebele B. Mink van der Molen & Emma C. Paes

  2. Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands

    Rosalie C. M. van Rees & Yente S. Beentjes

  3. Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Kevin Jenniskens

  4. Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Kevin Jenniskens

  5. Speech and Language Therapy, Wilhelmina Children’s Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands

    Sarah J. Haverkamp

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  1. Lieke Hofman
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  2. Joris A. van Dongen
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  7. Aebele B. Mink van der Molen
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Contributions

E. Paes, A. Mink van der Molen, and L. Hofman had the idea for the manuscript. L. Hofman and R. van Rees performed the literature search; L. Hofman and K. Jenniskens performed the data analysis; Y. Beentjes created Figs. 1–3; L. Hofman wrote the manuscript text; J. van Dongen, S. Haverkamp, E. Paes, and A. Mink van der Molen critically revised the manuscript.

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Correspondence to Lieke Hofman.

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Hofman, L., van Dongen, J.A., van Rees, R.C.M. et al. Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis. Clin Oral Invest 28, 58 (2024). https://doi.org/10.1007/s00784-023-05391-7

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