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CLEFT LIP AND PALATE. CLINICAL STUDIES REGARDING SPEECH AND FACIAL GROWTH

Farzaneh, Farokh LU (2009) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2009:71.
Abstract
Cleft lip and palate (CLP), the most common of all craniofacial anomalies, has an incidence about 2 per 1000 births in the Scandinavian countries. The Department of Plastic and Reconstructive Surgery in Malmö has been a regional centre in southern Sweden for the treatment of patients with CLP since 1954 with about 40 new cases of clefts each year. Speech and facial growth are important objectives in the treatment for CLP and these are thought to depend on the primary surgery during infancy.

Between 1954 and 1976 we operated on the lip using Millard´s technique and the palate was repaired early according to von Langenbeck’s technique (L-group). From 1976 to 1996, the lip was repaired by a two-stage procedure – the Johansson-Randall... (More)
Cleft lip and palate (CLP), the most common of all craniofacial anomalies, has an incidence about 2 per 1000 births in the Scandinavian countries. The Department of Plastic and Reconstructive Surgery in Malmö has been a regional centre in southern Sweden for the treatment of patients with CLP since 1954 with about 40 new cases of clefts each year. Speech and facial growth are important objectives in the treatment for CLP and these are thought to depend on the primary surgery during infancy.

Between 1954 and 1976 we operated on the lip using Millard´s technique and the palate was repaired early according to von Langenbeck’s technique (L-group). From 1976 to 1996, the lip was repaired by a two-stage procedure – the Johansson-Randall concept. Palate repair was postponed to about 18 months of age and performed using Wardill’s technique (W-group). Hence, there was a unique opportunity to study two long periods during which different strategies of primary repair were used according to standardized protocols. Altogether 97 adult patients were investigated for this long term follow-up.

The first two studies describe the outcome in patients with unilateral CLP (UCLP) regarding speech (I) and facial growth (II). Only slight speech quality differences were observed between the two groups. The findings possibly favour the L-groups, though at the expense of an increased need for a complementary speech improving operation. The L- and W-groups showed similar results regarding facial growth.

Studies III and IV describe similarly the long-term outcome in patients with bilateral CLP (BCLP), respectively. Also in patients with BCLP, only minor differences were noted between groups L and W. However, as in UCLP, the outcome regarding speech possibly favoured the L-group. Concerning facial growth, the results were again compatible.

UCLP is generally associated with the better results regarding speech and facial growth, in the long-term perspective. BCLP is associated with the more marked deviation of facial morphology, and the rate of complementary operations, including those intended to improve speech, is more frequent. (Less)
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author
supervisor
opponent
  • Professor Elander, Anna, Department of Clinical Sciences, University of Gothenberg
organization
publishing date
type
Thesis
publication status
published
subject
keywords
speech, cranio-facial morphology, perceptual speech analysis, long-term results, unilateral cleft lip and palate, cephalometry, von Langenbeck, bilateral cleft lip and palate, Wardill
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2009:71
pages
119 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Lecture hall at the Department of Medicine, entrance 35, Malmö University Hospital, Malmö.
defense date
2009-11-05 13:00
ISSN
1652-8220
ISBN
978-91-86253-59-2
language
English
LU publication?
yes
id
a04c182d-59e1-4374-b5f3-8dc4d100f2eb (old id 1474085)
date added to LUP
2009-09-29 13:10:54
date last changed
2016-09-19 08:44:48
@phdthesis{a04c182d-59e1-4374-b5f3-8dc4d100f2eb,
  abstract     = {Cleft lip and palate (CLP), the most common of all craniofacial anomalies, has an incidence about 2 per 1000 births in the Scandinavian countries. The Department of Plastic and Reconstructive Surgery in Malmö has been a regional centre in southern Sweden for the treatment of patients with CLP since 1954 with about 40 new cases of clefts each year. Speech and facial growth are important objectives in the treatment for CLP and these are thought to depend on the primary surgery during infancy.<br/><br>
Between 1954 and 1976 we operated on the lip using Millard´s technique and the palate was repaired early according to von Langenbeck’s technique (L-group). From 1976 to 1996, the lip was repaired by a two-stage procedure – the Johansson-Randall concept. Palate repair was postponed to about 18 months of age and performed using Wardill’s technique (W-group). Hence, there was a unique opportunity to study two long periods during which different strategies of primary repair were used according to standardized protocols. Altogether 97 adult patients were investigated for this long term follow-up.<br/><br>
The first two studies describe the outcome in patients with unilateral CLP (UCLP) regarding speech (I) and facial growth (II). Only slight speech quality differences were observed between the two groups. The findings possibly favour the L-groups, though at the expense of an increased need for a complementary speech improving operation. The L- and W-groups showed similar results regarding facial growth.<br/><br>
Studies III and IV describe similarly the long-term outcome in patients with bilateral CLP (BCLP), respectively. Also in patients with BCLP, only minor differences were noted between groups L and W. However, as in UCLP, the outcome regarding speech possibly favoured the L-group. Concerning facial growth, the results were again compatible.<br/><br>
UCLP is generally associated with the better results regarding speech and facial growth, in the long-term perspective. BCLP is associated with the more marked deviation of facial morphology, and the rate of complementary operations, including those intended to improve speech, is more frequent.},
  author       = {Farzaneh, Farokh},
  isbn         = {978-91-86253-59-2},
  issn         = {1652-8220},
  keyword      = {speech,cranio-facial morphology,perceptual speech analysis,long-term results,unilateral cleft lip and palate,cephalometry,von Langenbeck,bilateral cleft lip and palate,Wardill},
  language     = {eng},
  pages        = {119},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {CLEFT LIP AND PALATE. CLINICAL STUDIES REGARDING SPEECH AND FACIAL GROWTH},
  volume       = {2009:71},
  year         = {2009},
}