Scandcleft Randomized Trials of Primary Surgery for Unilateral Cleft Lip and Palate: Speech Proficiency at 10 Years of Age

Elisabeth Willadsen, Line Dahl Jørgensen, Suvi Alaluusua, Nina Helen Pedersen, Joan Bogh Nielsen, Elina Hölttä, Øydis Hide, Christine Hayden, Christina Havstam, Inger Lundeborg Hammarström, Julie Davies, Maria Boers, Helene Søgård Andersen, Ragnhild Aukner, David Jackson Morris, Søren Feodor Nielsen, Gunvor Semb, Anette Lohmander, Christina Persson*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

72 Downloads (Pure)


Background & Aim: To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project.

Methods & Procedures: Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B–Lip and soft palate closure at 3–4 months, hard palate closure at 36 months, Arm C–Lip closure at 3–4 months, hard and soft palate closure at 12 months, and Arm D–Lip closure at 3–4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A–Lip and soft palate closure at 3–4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported.

Outcomes & Results: The mean levels of consonant proficiency (PCC score) in the trial arms were 86–92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50–73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%).

Conclusions & Implications: The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years.
TidsskriftInternational Journal of Language & Communication Disorders
Udgave nummer3
Sider (fra-til)892-909
Antal sider18
StatusUdgivet - maj 2023


  • Consonant proficiency
  • Palatal surgical protocols
  • Randomizedcontrolled trial (RCT)
  • Unilateralcleft lip and palate (UCLP)
  • Velopharyngeal competence (VPC)
  • Velopharyngeal incompetence(VPI