Speech Characteristics of Cleft Palate
Jamie is only 22 months old. He was born with a cleft lip and palate but the condition was repaired at 3 months and 9 months respectively. When children are born, the children we look forward to according to most parent’s expectations would be physically absolutely perfect. The birth of a child with a congenital malformation is a trauma to the parents, especially when it comes to the cleavage of the palate and the lip, which is an incomplete fusion of the skin, muscles and bones during embryonic development. Many parents have never seen or heard anything like this, and so they have many questions about this pathology, its treatment and assistance to the child during his growing up. This publication will help readers find answers to many questions about cleft lip (Acharya, Chen, Lewis, Teichgraeber, & Lypka, 2015).
Cleft palate speech is described in terms of nasal resonance, nasal emission and articulations in compensatory. A study on different longitudinal stages of surgical treatment revealed between active and passive cleft type of speech characteristics. Passive characteristics of cleft palate are believed to be a product of dysfunction and structural abnormality while active characteristics were specific articulation structures that replaces intended consonants. Passive and active characteristics of articulatiosn are defined in the context of three longitudinal studies of different surgical regimes. The lack of differentiation in speech is irrespective of their surgical status. Cleft type processes in completely repaired palates verses residual cleft.
Many parents are quite rightly convinced that information on cleft lip and palate, coupled with the support of the treating surgeon, greatly facilitates the process of care and treatment of the child. The information is presented in the order in which the questions usually arise during the passage of various stages of cleft lip treatment. We specially formulated these questions in the simplest and most generalized form, since each small patient needs an absolutely individual approach depending on a variety of factors and attendant conditions (Colbert, Green, Brennan, & Mercer, (2015).
The article emphasize that it is absolutely impossible to mention all the ways of treating cleft lip, because besides the already mentioned reasons, the methods of treatment are subject to constant evolution, and what was adopted yesterday is now scientifically outdated and is not applied in practice(Gopal, & Louw, 2017).
Most likely you first hear about such a concept of cleft lip and palate, so some information will be useful for you. Splitting of the lip or palate is an incomplete fusion of the skin, muscles and bones that occurs during the period of embryonic development. Splitting of the lip can be partial or complete. In addition, it can be either one-way or two-way. In the event that lip cleavage is observed only on one side of the face, this pathology is called a monolateral splitting and in the case of pathology on both sides, this splitting is bilateral (Howe, Lee, Sharp, Smith, & Zhukov, 2018)..
Treatment and Assistance for Cleft Lip and Palate
Often, Lateral cleavage the splitting of the lips is accompanied by the splitting of the palate to one degree or another: only its hard or only its soft part. Depending on the degree of severity of the cleft, one of two procedures is used. After all the tests, the surgery for correcting the lip and nose, as well as the splitting of the soft palate, is performed (Jones, Parker, Mai, Canfield, Rickard, Wang, & Kirby, 2018).
Sometimes this operation is combined with the procedure for joining the split hard palate, however, it is not always possible to perform simultaneously, thus the alveolar process, i.e. the area where the baby’s teeth will grow will be modeled surgically by installing a bone implant upon reaching the child of 6-8 years of age. In case the hard palate remains open, during the second operation upon reaching the child 18-36 months of age, it will be restored simultaneously with the alveolar process, thus avoiding the subsequent implantation operation. It is important to remember that the closure of the cleft lip and palate is carried out using only the child’s tissue (Liang, Shapiro, & Tse, 2017).
Postoperative care is explained to you by the surgeon and / or hospital medical staff. The scar of the lip becomes lighter and thinner for several months, but will always be slightly visible. Sometimes surgical procedures may be performed that are somewhat different from those described in relation to the specific situation of each child. The surgeon decides and tells the parents the treatment protocol that guarantees the best results in each case. At the direction of the speech therapist, a very small number of children aged 4-5 years undergo another surgery to improve the ability to reproduce the sound. Treatment of isolated cleft In this case, only one operation is needed. The lip surgery is performed when the child reaches the age of 6 months. The duration of the operation depends on many parameters, therefore it is determined separately in each case (Lloyd, Cleland & Palo, 2018)..
For Jamie and other children with orofacial cleft, the anomalies requires years of specialiozed care and its very costly. The involvement of children with CP with an otolaryngologist is a multidiplinary paln that is very important. The specialist perfoms placement of ventilation tubes in conjuction with cleft palate repair. No single treatment plan is recommended, however, include
- Newborn- diagnostic examination has been identified especially in palatal obturator. The empiric risk of occurrence of cleft is calculated.
- Age 3 months- the repair of the cleft lip is done
- Age 6 months-first speech evaluation
- Age 9 months- speech therapy begins
- Age 9-12 months- repair of the cleft palate
- Age 1-7 – orthodontic treatment
- Age 7-8- alveolar graft bone
- Above the age orthodontic treatment continues.
- Short term goals and specific target selection for therapy
The identification and rational solution of the problems of medical and social rehabilitation of patients with cleft lip and palate are quite consistent with the goals and objectives which include
- Repair of the cleft lip for Jamie while still very young
- Speech evaluation
- Cleft palate repair..
Limitations of Treatment Methods
Elements of achieving the quality of rehabilitation characterize the level of organization of a modern medical and preventive institution, which allows to effectively combine intellectual potential and material resources, ensure the achievement of high results (Nierzwicki, & Daifallah, 2015).
We can say that the integrated approach has become the only possible in the current conditions and only it brings optimal results. It is therefore natural that in recent years, maxillofacial surgeons have paid special attention to the solution of numerous problems of the development and improvement of a comprehensive rehabilitation system for patients with speech impairment after primary uranolastics.
Violations of speech and the causes of their occurrence are thoroughly studied by physiologists, psychologists, linguists, etc. It is especially important that each specialist considers speech disturbances from a certain angle in accordance with the tasks and means of his science. The study of speech disorders and the development of scientifically based methods for their detection, prevention and elimination are the focus of numerous studies by associate scientists (Rocha, Oliveira, Costa, Pires, Diniz, & Soares, 2017)..
Our analysis of the causes of unsatisfactory results of operations showed that many of them were performed either without an exact choice of tactics (method, method), or without a comprehensive account of the degree and form of congenital pathology, the age of the child, without an integrated approach to the entire rehabilitation process. We believe that the congenital cleft of the upper lip and palate requires exclusively specialized medical care, including the efforts of competent specialists of various profiles.
The essence of these measures lies in the medical-psychological-pedagogical complex impact on special and general mechanisms for regulating the functions of the body with a view to improving their effectiveness. A primary examination of patients is carried out in the clinical and diagnostic department (Sun, Huang, Y., Yin, Pan, Wang, Wang, & Wang, 2015)..
Preparation of an individual program of examination and treatment was carried out by commission by all involved in the process of examination and diagnosis by specialists. A pediatrician’s examination was aimed at diagnosing, evaluating the patient’s health. Correction was carried out if necessary.
References
Acharya, B. S., Chen, E. A., Lewis, R. L., Teichgraeber, J. F., & Lypka, M. A. (2015). A Postsurgical Obturator After Cleft Lip Repair in Patients With Holoprosencephaly. The Cleft Palate-Craniofacial Journal, 52(4), 480-483.
Colbert, S. D., Green, B., Brennan, P. A., & Mercer, N. (2015). Contemporary management of cleft lip and palate in the United Kingdom. Have we reached the turning point?. British Journal of Oral and Maxillofacial Surgery, 53(7), 594-598.
Gopal, R., & Louw, B. (2017). Island Voices: Experiences of Living with Cleft Lip and or Palate.
Howe, L. J., Lee, M. K., Sharp, G. C., Smith, G. D., St Pourcain, B., Shaffer, J. R., … & Zhurov, A. (2018). Investigating the shared genetics of non-syndromic cleft lip/palate and facial morphology. PLoS genetics, 14(8), e1007501.
Jones, M. C., Parker, S. E., Mai, C. T., Canfield, M. A., Rickard, R., Wang, Y., … & Kirby, R. S. (2018). Anomalies associated with cleft lip, cleft palate, or both. The Cleft Palate-Craniofacial Journal, 55(1), 137-156.
Liang, S., Shapiro, L., & Tse, R. (2017). Measuring Symmetry in Children With Cleft Lip. Part 3: Quantifying Nasal Symmetry and Nasal Normalcy Before and After Unilateral Cleft Lip Repair. The Cleft Palate-Craniofacial Journal, 54(5), 602-611.
Lloyd, S., Cleland, J., Crampin, L., Campbell, L., Zharkova, N., & Palo, J. P. (2018). Visualising speech: identification of atypical tongue-shape patterns in the speech of children with cleft lip and palate using ultrasound technology. Craniofacial Society of Great Britain and Ireland.
Nierzwicki, B., & Daifallah, T. (2015). Cleft Lip Repair. Atlas of Operative Oral and Maxillofacial Surgery, 27.
Rocha, M. O., Oliveira, D. D., Costa, F. O., Pires, L. R., Diniz, A. R., & Soares, R. V. (2017). Plaque index and gingival index during rapid maxillary expansion of patients with unilateral cleft lip and palate. Dental press journal of orthodontics, 22(6), 43-48.
Sun, Y., Huang, Y., Yin, A., Pan, Y., Wang, Y., Wang, C., … & Wang, G. (2015). Genome-wide association study identifies a new susceptibility locus for cleft lip with or without a cleft palate. Nature communications, 6, 6414.
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