Clinical Research And Therapy Of Pathological Speech After Cleft Palate Surgery

Cleft lip and palate is the most frequent congenital malformation which happens in the oral-maxillofacial. The curing principle is the cleft lip and palate team approach, which means that it needs different team members to participate in the team approach, such as the oral-maxillofacial surgeon,pediatrician otolaryngologists,orthodontist,prosthodontics physicians,speech pathologist,psychologist,and so on. And speech therapy after cleft palate surgery has been generally accepted as an important part during comprehensive sequence of treatment. Because there are still 20%～30% of patients with varying degrees of velopharyngeal insufficiency and compensatory articulation habits after early cleft palate repair surgery, which cause pathological cleft palate speech. Moreover, most patients and their families are lack of understanding on postoperative functional training and speech therapy, and they think that the problem of speech intelligibility can be solved by surgery. Currently, Cleft Lip and Palate Treatment Center has been set up in Beijing,Shanghai,Chengdu, et al, which make the treatment of cleft lip and palate form a scientific and standardized treatment procedures from surgery to speech therapy, until recovery. Therefore a large number of valuable information and experiences were accumulated from the effective first visit and return visit regimen, which greatly improve speech therapy. To fundamentally improve the treatment level of cleft palate of Henan province, postoperative patients'speech should be regularly assessed.Objective:To improve the speech intelligibility of patients after cleft palate repair surgery and explor the relationship between blowing training and speech therapy, and also provide theoratical basis for clinical speech therapy,66 patients were taught about the speech training and given speech therapy.Methods:66 patients with 39 males and 27 females, aged from 2.5 to 35 years old, with median age of 7 years, were selected from the patients with speech disorders and after cleft palate repair coming to Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University for return visit during August 2009 to March 2011 Blowing training was used for the patients aged below 5 years to increase the function of velopharyngeal muscle; This training was also used for the patients elder than 5 years to reduce nose leakage, meanwhile, speech therapy was done through various methods. Training sequence was followed by and the form of one to one training was taken during the research. Blowing-test and speech intelligibility tests before and after training were both checked up. The data was analysed with SPSS 16.0 software.Results:1.After training, blowing-test time of all patients has been longer than the time before training.2. For the patients younger than 5 years old, the average blowing-test of each group increased gradually after 1 month,3 months,6 months'training.3. For the patients who trained over 2 hours per day, their average blowing-test increased more quickly than those who trained between 30 minute tol hour per day.4. The length of training time per day had significant effect on the blowing-test (P= 0.000<0.01), and during the same time period, variance of the patient's blowing-test was significant(P=0.006<0.01) for the patients younger than 5 years old.5. For the patients elder than 5 years old, the patient's speech intelligibility was significantly related to the time of speech therapy, but there was no significant relationship between blowing-test and the time of speech therapy (P=0.334>0.05), and there was no significant relationship between the improvement of blowing-test and speech intelligibility (P=0.344>0.05)6. Only when the one who got over ten times of speech therapy, the improvement of speech intelligibility increased greatly with the time of speech therapy; but when less than ten times, the improvement increased slowly.CONCLUSIONS:1. All the patients'blowing-test has been improved.2. For the one who trained over two hours per day, their blowing-test increased obviously.3. Speech intelligibility could improve significantly when undergoing over ten times of speech therapy, thus the treatment for pathological speech has to be a gradual continuous process.4. Blowing training alone couldnot improve speech intelligibility, speech therapy should also be applied with. 5. The evaluation of speech intelligibility for all the patients has to be followed up.