The Impact of Maxillary Osteotomy on Speech Outcomes in Cleft Lip and Palate: An Evidence-Based Approach to Evaluating the Literature

Abstract

Objective

To undertake a critical and systematic review of the literature on the impact of maxillary advancement on speech outcomes in order to identify current best evidence.

Design and Main Outcome Measures

The following databases were searched: PubMed, CINAHL, and The Cochrane Controlled Trials Register. In addition, reference lists were hand searched for additional articles. Using a predefined framework and set criteria, evidence was evaluated using the assignment of levels of evidence (at least Level III on the evidence hierarchy), calculation of post-hoc power (≥ 0.8), effect size (Cohen's d ≥ 0.5), and adaptation of the parameters as set out by The Cochrane Collaboration.

Results

Of the 40 studies identified, the majority (68%) fell within Level lll.ii, representing cohort-type studies and a fifth (20%) within Level IV, the weakest form of evidence. Power and effect size calculations were only possible in 9 studies for different speech outcomes, and only seven studies met the set criteria for best evidence. Accordingly, current best evidence for articulation exists only for a noncleft population, is conflicting for resonance and nasalance, and is mixed for velopharyngeal function depending on which instrumental measure is used.

Conclusions

There is an obvious need for further prospective research in the field with strong speech methodology such as the undertaking of interrater and intrarater reliability, adequate follow-up, and sufficient sample sizes based on a priori power analyses. Methodologic issues are discussed and recommendations made.

Keywords

cleft lip and palate (CLP)maxillary advancement nasality osteotomy speech velopharyngeal function

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References

Briggs

Joanna Briggs Institute (JBI) of levels of evidence. Available at http://www.joannabriggs.edu.au. Accessed June 25, 2009.

Chanchareonsook

Samman

Whitehill

T.L.

The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: a critical review.

Cleft Palate Craniofac J. 2006; 43: 477–487.

Cheng

T.H.

Direct Magnitude Estimation Versus Visual Analog Scaling in the Rating of Hypernasality. Hong Kong: University of Hong Kong; 2006. Dissertation.

Coe

It's the effect size, stupid: what effect size is and why it is important. 2002. Available at http://www.leeds.ac.uk/educol/documents/00002182.htm. Accessed May 20, 2011.

Cohen

A power primer.

Psychol Bull. 1992; 112: 155–159.

Dalston

R.M.

Marsh

J.L.

Vig

K.W.

Witzel

M.A.

Bumsted

R.M.

Minimal standards for reporting the results of surgery on patients with cleft lip, cleft palate, or both: a proposal.

Cleft Palate J. 1988; 25: 3–7.

Department of Health. Consent - What You Have a Right to Expect. A Guide for Children and Young People. London: Crown Copyright; 2001.

Department of Health. Best Research for Best Health: A New National Health Research Strategy. London: DH Publications; 2006. Report No. 272605.

Egger

Smith

G.D.

Phillips

A.N.

Meta-analysis: principles and procedures.

BMJ. 1997; 315: 1533–1537.

10.

Enderby

Emerson

Does Speech and Language Therapy Work? A Review of the Literature. London: Whurr Publishers; 1995.

11.

Euser

A.M.

Zoccali

Jager

K.J.

Dekker

F.W.

Cohort studies: prospective versus retrospective.

Nephron Clin Pract. 2009; 113: c214–c217.

12.

Fant

Acoustic Theory of Speech Production. The Hague: Mouton; 1970.

13.

Faul

Erdfelder

Lang

A.G.

Buchner

G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.

Behav Res Methods. 2007; 39: 175–191.

14.

Gilleard

Sommerlad

Sell

Ghanem

Birch

Nasendoscopic Image Analysis: An Analysis of Measurement Uncertainties. In: Raposo do Amaral

C.E.

Albino de Almeida

A.B.

, eds. International Proceedings of the 11th International Congress on Cleft Lip and Palate and Related Craniofacial Anomalies. Bologna, Italy: Medimond; 2009.

15.

Golding-Kushner

K.J.

Argamaso

R.V.

Cotton

R.T.

Grames

L.M.

Henningsson

Jones

D.L.

Karnell

M.P.

Klaiman

P.G.

Lewin

M.L.

Marsh

J.L.

. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group. Cleft Palate J. 1990; 27: 337–347.

16.

Good

P.M.

Mulliken

J.B.

Padwa

B.L.

Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate.

Cleft Palate Craniofac J. 2007; 44: 396–401.

17.

Henningsson

Kuehn

D.P.

Sell

Sweeney

Trost-Cardamone

J.E.

Whitehill

T.L.

Universal parameters for reporting speech outcomes in individuals with cleft palate.

Cleft Palate Craniofac J. 2008; 45: 1–17.

18.

John

Sell

Sweeney

Harding-Bell

Williams

The cleft audit protocol for speech-augmented: a validated and reliable measure for auditing cleft speech.

Cleft Palate Craniofac J. 2006; 43: 272–288.

19.

Jones

Dunaway

Hayward

Surgery. In: Hayward

Jones

Dunaway

Evans

, eds. The Clinical Management of Craniosynostosis. London: MacKeith Press; 2004.

20.

Kataoka

Michi

Okabe

Miura

Yoshida

Spectral properties and quantitative evaluation of hypernasality in vowels.

Cleft Palate Craniofac J. 1996; 33: 43–50.

21.

Keuning

K.H.

Wieneke

G.H.

Dejonckere

P.H.

Correlation between the perceptual rating of speech in Dutch patients with velopharyngeal insufficiency and composite measures derived from mean nasalance scores.

Folia Phoniatr Logop. 2004; 56: 157–164.

22.

Klinto

Salameh

E.K.

Svensson

Lohmander

The impact of speech material on speech judgment in children with and without cleft palate.

Int J Lang Commun Disord. 2010 Sep 14 [Epub ahead of print].

23.

Kreiborg

Hermann

N.V.

Darvann

T.A.

Characteristics of facial morphology and growth in infants with clefts. In: Berkowitz

, ed. Cleft Lip and Palate. Diagnosis and Management. 2nd ed. New York: Springer; 2005: 225–235.

24.

Kuehn

D.P.

Moller

K.T.

Speech and language issues in the cleft palate population: the state of the art.

Cleft Palate Craniofac J. 2000; 37: 348.1–348.35.

25.

Kuehn

D.P.

Moon

J.B.

Velopharyngeal closure force and levator veli palatini activation levels in varying phonetic contexts.

J Speech Lang Hear Res. 1998; 41: 51–62.

26.

Kummer

A.W.

Cleft Palate and Craniofacial Anomalies. San Diego: Singular; 2001. Kummer AW, Briggs M, Lee L. The relationship between the characteristics of speech and velopharyngeal gap size.

Cleft Palate Craniofac J. 2003; 40: 590–596.

27.

Lello

G.E.

Orthognathic surgery. In: Watson

A.C.H.

Sell

D.A.

Grunwell

, eds. Management of Cleft Lip and Palate. London and Philadelphia: Whurr Publishers; 2005: 338–351.

28.

Lohmander

Olsson

Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the Literature.

Cleft Palate Craniofac J. 2004; 41: 64–70.

29.

Lohmander

Willadsen

Persson

Henningsson

Bowden

Hutters

Methodology for speech assessment in the Scandcleft project—an international randomized clinical trial on palatal surgery: experiences from a pilot study.

Cleft Palate Craniofac J. 2009; 46: 347–362.

30.

Lubker

J.F.

Normal velopharyngeal function in speech.

Clin Plast Surg. 1975; 2: 249–259.

31.

Mars

Facial growth. In: Watson

A.C.H.

Sell

D.A.

Grunwell

, eds. Management of Cleft Lip and Palate. London and Philadelphia: Whurr Publishers; 2005: 44–67.

32.

Mars

Plint

D.A.

Houston

W.J.B.

Bergland

Semb

The Goslon Yardstick: a new system of assessing dental arch relationships in children with cleft lip and palate.

Cleft Palate J. 1987; 24: 314–322.

33.

Moher

Tsertsvadze

Tricco

A.C.

Eccles

Grimshaw

Sampson

Barrowman

When and how to update systematic reviews.

Cochrane Database of Systematic Reviews. 2008; 1: Art No: MR000023.

34.

Pereira

V.J.

The Effect of Maxillary Advancement on Speech, Nasality and Velopharyngeal Function in Cleft Lip and Palate. London: University College London Institute of Child Health; 2007.

35.

Transfer report (upgrade of research degree from M.Phil. to Ph.D.). Peterson-Falzone

S.J.

Hardin-Jones

M.A.

Karnell

M.P.

Instrumentation for assessing the velopharyngeal mechanism. In: Peterson-Falzone

S.J.

Hardin-Jones

M.A.

Karnell

M.P.

, eds. Cleft Palate Speech. 3rd ed. St. Louis: Mosby; 2001: 243–272.

36.

Pring

Research Methods in Communication Disorders. London and Philadelphia: Whurr Publishers; 2005.

37.

Proffit

White

W.R.

Dentofacial problems: prevalence and treatment need. In: Proffit

Sarver

, eds. Contemporary Treatment of Dentofacial Deformities. St. Louis: Mosby; 2003: 2–28.

38.

Reilly

Douglas

Oates

Evidence Based Practice in Speech Pathology. London and Philadelphia: Whurr Publishers; 2004.

39.

Ross

R.B.

Treatment variables affecting facial growth in complete unilateral cleft lip and palate.

Cleft Palate J. 1987; 24: 5–77.

40.

Sackett

D.L.

Rosenberg

W.M.

Gray

J.A.

Haynes

R.B.

Richardson

W.S.

Evidence based medicine: what it is and what it isn't.

BMJ. 1996; 312: 71–72.

41.

Sell

Issues in perceptual speech analysis in cleft palate and related disorders: a review.

Int J Lang Commun Disord. 2005; 40: 103–121.

42.

Sell

Grunwell

Speech assessment and therapy. In: Watson

A.C.H.

Sell

Grunwell

, eds. Management of Cleft Lip and Palate. London and Philadelphia: Whurr Publishers; 2005: 227–257.

43.

Sell

Harding

Grunwell

GOS.SPASS.'98: An assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised).

Int J Lang Commun Disord. 1999; 34: 17–33.

44.

Sell

John

Harding-Bell

Sweeney

Hegarty

Freeman

Cleft audit protocol for speech (CAPS-A): a comprehensive training package for speech analysis.

Int J Lang Commun Disord. 2009; 44: 529–548.

45.

Shaw

W.C.

Semb

Choosing the best treatment for the child with a cleft. In: Watson

A.C.H.

Sell

Grunwell

, eds. Management of Cleft Lip and Palate. London and Philadelphia: Whurr Publishers; 2005: 386–403.

46.

Smith

B.E.

Guyette

T.W.

Pressure-flow differences in performance during production of the CV syllables /pi/ and /pa/.

Cleft Palate Craniofac J. 1996; 33: 74–76.

47.

Sweeney

Sell

Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction.

Int J Lang Commun Disorder. 2008; 43: 265–282.

48.

The Cochrane Collaboration. Evidence-based healthcare and systematic reviews. Available at http://www.cochrane.org/about-us/evidence-based-health-care. Accessed July 12, 2011.

49.

The Cochrane Collaboration Open Learning Material. Summary statistics for dichotomous outcome data. Available at http://www.cochrane-net.org/openlearning/HTML/mod11-2.htm. Accessed May 11, 2011.

50.

The Cochrane Library. About Cochrane systematic reviews and protocols. Available at http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html. Accessed July 6, 2011.

51.

The Oxford Centre for Evidence Based Medicine. Levels of evidence. Available at http://www.cebm.net/?o=5653. Accessed April 17, 2012.

52.

Trindade

I.E.K.

Efeitos da Cirurgia Ortognatica Sobre a Fala e a Respira Cao de Individuos Com Fissura Labio-Palatina: Analise Acustica e Acrodinamica. Bauru, São Paulo: University of São Paulo; 1999. Dissertation.

53.

Turvey

White

Surgical treatment. In: Proffit

Sarver

, eds. Contemporary Treatment of Dentofacial Anomalies. St. Louis: Mosby; 2003: 288–311.

54.

Vandenbroucke

J.P.

Prospective or retrospective: what's in a name?

BMJ. 1991; 302: 249–250.

55.

Vandenbroucke

J.P.

Observational research, randomised trials, and two views of medical science.

PLoS Med. 2008; 5: e67.

56.

Warren

D.W.

Perci: a method for rating palatal efficiency.

Cleft Palate J. 1979; 16: 279–285.

57.

Warren

D.W.

Dalston

R.M.

Mayo

Hypernasality in the presence of “adequate” velopharyngeal closure.

Cleft Palate Craniofac J. 1993; 30: 150–154.

58.

Warren

D.W.

Dalston

R.M.

Trier

W.C.

Holder

M.B.

A pressure-flow technique for quantifying temporal patterns of palatopharyngeal closure.

Cleft Palate J. 1985; 22: 11–19.

59.

Whitehill

T.L.

Nasalance measures in Cantonese-speaking women.

Cleft Palate Craniofac J. 2001; 38: 119–125.

60.

Whitehill

Rating hypernasality: current challenges and future directions. Presented at the meeting of the Craniofacial Society of Great Britain and Ireland Annual Conference; April 2010; Liverpool, U.K.

61.

Whitehill

Cheng

T.H.

Jones

Rating hypernasality: direct magnitude estimation (DME) versus visual analog scaling (VAS). Presented at the American Speech-Language-Hearing Association Annual Convention; November 15–17, 2007; Boston, Mass.

62.

Whitehill

T.L.

Lee

A.S.

Chun

J.C.

Direct magnitude estimation and interval scaling of hypernasality.

J Speech Lang Hear Res. 2002; 45: 80–88.

63.

Witzel

M.A.

Commentary.

Cleft Palate J. 1989; 26: 199–200.

64.

Zajac

Discussion.

J Oral Maxillofac Surg. 2002; 60: 372–373.