Speech Assessments in Hypoplastic Cleft Maxilla Treated by Anterior Segmental Distraction Osteogenesis

Abstract

Introduction: Cleft lip and palate (CLP) affect the craniofacial region, with significant implications for speech, hearing, feeding, and facial aesthetics. This study aimed to evaluate the impact of anterior maxillary segmental distraction osteogenesis (AMSDO) using an internal distractor on speech outcomes in CLP patients, assessed using the Pittsburgh Weighted Speech Scale (PWSS).
Methodology: A single-center prospective study was conducted between March 2022 and April 2024. Twelve CLP patients with maxillary hypoplasia, aged 17.8 to 32.6 years, were included. Purposive sampling was done to include patients with complete unilateral or bilateral CLP who exhibited Class III skeletal relationships with reverse overjet greater than 7 mm. Speech assessments were conducted preoperatively (1-3 months before surgery) and postoperatively (5-7 months after distraction). Speech samples were recorded and evaluated by a licensed speech-language pathologist using the PWSS. Statistical analysis was performed using paired t-tests and Chi-square tests.
Results: Significant improvements were observed in the total PWSS score (p = 0.03), nasality (p < 0.001), phonation (p < 0.001), and articulation errors (p = 0.004) postoperatively. No significant changes were seen in nasal emission and facial grimace. No correlation was found between the amount of distraction and speech outcomes. Unilateral cleft patients showed better outcomes than bilateral cleft patients, though not statistically significant.
Conclusion: AMSDO significantly improves speech outcomes in CLP patients with maxillary hypoplasia. The PWSS is a reliable tool for assessing these changes. Further research with larger samples and longer follow-ups is warranted to confirm these findings.