The purpose of this review is to investigate the speech outcomes of speech therapy only versus speech therapy in combination with Furlow palatoplasty for the treatment of velopharyngeal insufficiency (VPI) in submucous cleft palate (SMCP). Systematic review and 2 meta-analyses of speech therapy only and speech therapy in combination with Furlow palatoplasty in the treatment of VPI in SMCP. Secondary and tertiary care centres in 10 different countries spread over 6 continents. Articles were selected after an elaborate literature search using PubMed, Embase and the Cochrane Library. Speech therapy only and speech therapy in combination with Furlow palatoplasty MAIN OUTCOME MEASURE: The primary outcome measure of this study is the reduction of VPI-associated speech difficulties after treatment. Speech therapy only showed a risk difference (RD) of 0.015 to 0.036 for the presence of hypernasality; 0.045 for the presence of nasal emission; 0.015 for the presence of compensatory articulation and 0.089 for the presence of unintelligible speech. Speech therapy in combination with Furlow palatoplasty showed RDs of 0.46; 0.29 and 0.37 for the presence of hypernasality, clinically relevant hypernasality and nasal emission, respectively. Both speech therapy only and speech therapy in combination with Furlow palatoplasty demonstrate a decrease in VPI-associated speech difficulties in SMCP. According to the current findings, speech therapy should accompany surgical correction by Furlow for the treatment of SMCP. However, larger prospective studies are required to investigate the precise role of speech therapy as a standalone intervention in mild cases of SMCP.

Objective: This retrospective study aimed to evaluate the different conservative (ie, speech therapy) and surgical treatment approaches of velopharyngeal insufficiency (VPI) associated speech pathology in patients with submucous cleft palate (SMCP), performed within a single tertiary cleft care centre. Patients, Participants: Thirty-three patients treated for SMCP between January 1999 and December 2023, registered in a database of the Maastricht University Medical Centre and MosaKids Children’s Hospital and a database of the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA), were included. Main Outcome Measures: The decrease in VPI-associated speech pathology after treatment was retrospectively scored using the Cleft Audit Protocol for Speech-Augmented (CAPS-A) in the Dutch language, based on the Dutch Cleft Speech Evaluation Test (DCSET). Results: A significant reduction of the sum scores of the CAPS-A Dutch was seen in surgery combined with speech therapy (95% CI: 1.46–4.19) and speech therapy after surgery (95% CI: 0.85–3.48). Speech therapy only lowered the sum scores, but did not show a significant effect (95% CI: −1.30 to 1.30). Both surgical and conservative treatment resulted in a reduction of VPI-associated speech pathology, but only surgery significantly reduced hypernasality ( P =0.005) and improved speech intelligibility ( P =0.005). Conclusion: This study confirms the need for a multimodal treatment approach for VPI in SMCP by combining surgical cleft palate repair with pre- and post-operative specialised cleft speech therapy for optimal speech outcomes.

Objective: To evaluate speech outcomes in children with cleft palate following single-stage closure of the soft and hard palate. Design: A retrospective cohort study. Setting: Tertiary cleft care center at Maastricht University Medical Center+ (MUMC+), the Netherlands. Patients, Participants: A total of 47 children with cleft palate or cleft lip and palate who underwent single-stage palatal closure between 2011 and 2018. Children with syndromes associated with significant cognitive or developmental impairment precluding valid speech assessment were excluded. Interventions: Primary palatal repair using two-flap palatoplasty, Furlow double-opposing Z-plasty, or von Langenbeck technique. Main Outcome Measure(s): Speech was assessed using the Dutch Cleft Speech Evaluation Test (DCSET) and the Dutch version of the Cleft Audit Protocol for Speech – Augmented (CAPS-A). Secondary outcomes included prevalence of otitis media with effusion (OME) and tympanostomy tube placement. Results: Speech intelligibility improved significantly at the final assessment (median score 2 to 1; P <0.001). No significant changes were found in voice, hypernasality, hyponasality, nasal emission, nasal turbulence, or grimace. CAPS-A analysis showed resolution of palatalisation errors, but increased dentalisation/interdentalisation, likely reflecting temporary compensatory articulation. OME was present in 90.7% of children, and 97.6% required at least one tympanostomy tube. Conclusion: Single-stage palatal closure leads to improved speech intelligibility with stable outcomes across other speech parameters. High prevalence of middle ear disease underscores the need for multidisciplinary follow-up.

Objective: This study aims to provide exploratory data on the otological disease burden in submucous cleft palate (SMCP) and evaluate the effect of ventilation tubes and (other otological) surgery on hearing loss. Methods: SMCP patients treated at the Maastricht University Medical Centre (MUMC+) between January 1999 and December 2023, registered in a database of the MUMC+ and MosaKids Children’s Hospital, and national registry of the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA), were retrospectively reviewed. Outcome measures include (acute) otitis media with or without effusion (AOM/OME), ventilation tube placement ((non-)concurrent with cleft repair) and hearing loss defined as a High Fletcher Index (HFI)> 30 dB. Results: 33 SMCP patients were included. Twenty-nine patients had a history of AOM/OME and 27 patients received ventilation tubes. Ventilation tube placement resulted in a significant improvement in hearing, with a decrease in the HFI for the left and right ear (6.6 dB vs 10.6 dB, p15 years). Conclusion: SMCP patients show a high otological disease burden, with combined ventilation tube use and cleft repair showing a potential for long-term improved hearing.

Treatment of cleft lip alveolus and/or palate includes surgical repair to treat communication-related outcomes such as velopharyngeal insufficiency and otological dysfunction. Robot-assisted surgery has recently evolved into a promising adjunct to conventional surgery, particularly for complex procedures such as transoral (reconstructive) surgery. This structured literature review aims to investigate whether robot-assisted transoral cleft palate repair enhances communication (i.e., speech and otological) outcomes compared to conventional manual cleft palate surgery. A literature search was performed using PubMed, Embase, the Cochrane Library and Google Scholar. Primary outcomes were the change in cleft speech characteristics and otological disease after robot-assisted cleft palate surgery versus manual cleft palate surgery. The available evidence on communication-related outcomes remains sparse. Six relevant articles were included. In only one study, transoral robotic cleft surgery (TORCS) significantly reduced otitis media with effusion (OME), need for ventilation tubes and hearing threshold within 2 years post-surgery. No postoperative speech or velopharyngeal outcomes were reported. In conclusion, transoral robotic cleft surgery (TORCS) appears safe and feasible for repair of a cleft palate. It provides superior intraoral view and improved surgeon ergonomics. Current drawbacks are the costs and the available tools, the extended surgical duration and the lack of haptic feedback, which limit the current clinical applicability of TORCS. Based on limited clinical evidence, TORCS may support faster recovery of Eustachian tube function and hearing, but no conclusions on speech outcomes can yet be drawn.