**Surgical Strategy of Cleft Palate Repair and Nasometric Results Results**

**Surgical Strategy of Cleft Palate Repair and Nasometric** 

Norifumi Nakamura and Masahiro Tezuka Norifumi Nakamura and Masahiro Tezuka Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/67093

#### **Abstract**

The goal of cleft palate (CP) repair is to achieve normal speech. Despite the recent development of surgical repair of cleft palate, there is no standard procedure that ensures patients' speech to the same level as that in noncleft children. In this chapter, we describe our surgical strategy of cleft palate repair that approaches each anatomical and pathological abnormality of cleft palate and the postoperative speech outcomes using the subjective and objective manners. After palate repair based on our surgical strategy, patients' speech was significantly improved, and the nasalance scores were recovered to almost the same levels as those of Japanese children without cleft palate.

**Keywords:** cleft palate, palatal repair, nasometry, speech

### **1. Introduction**

The surgical goals of primary repair for cleft palate (CP) include closure of the defect of the hard and soft palate and achievement of normal speech based on favorable velopharyngeal (VP) closure. Patients and family members always desire their speech in the same level as that of healthy children. However, it is said that approximately 40% of patients have a persistent, often lifelong, speech impairment in connected to CP [1]. Despite the recent development of surgical repair of cleft palate, there has been no standard procedure that can ensure complete VP closure (VPC) in patients with CP to date.

The Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, worked on cleft lip and palate repair for 30 years. We assessed their speech from 2000 to 2005 and revealed that more than 30% of patients had a moderate or poor VPC, and only 40% had achieved normal articulation. Therefore, to improve our speech results, the following countermeasures were carried out: First, we tried to standardize the surgical procedures for pala-

tal repair. Second, postoperative speech results were assessed objectively by speech language therapists (SLT). Third, these objective data were shared with all surgeons to provide feedback for the next operation.

In this chapter, we described our surgical strategy of cleft palate repair that approaches each anatomical and pathological abnormality of cleft palate and evaluated postoperative speech outcomes including presence/severity of hypernasality, nasal emission, and nasalance scores after standardize palatal repair. We then compared speech outcomes to ones using our previous palatal repair protocol without following surgical strategy. Furthermore, we also compared them to the nasalance scores of Japanese noncleft children.
