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Voice correction surgery is often necessary for individuals with cleft palate, as it addresses pronunciation issues that may persist after initial cleft repair. The primary concern for babies born with cleft palate is the potential for speech problems, such as a nasal sound that affects clarity. Traditional cleft palate surgery can leave 20-30% of patients with ongoing voice issues, necessitating further intervention. Without addressing this, individuals may face social and professional challenges later in life.
Among patients who have undergone cleft lip and palate surgeries, approximately 6% require voice correction surgery. This rate aligns closely with the world's best-reported figures of 5.5%, indicating strong outcomes in standard medical practice.
After cleft palate surgery at around one year of age, the first language assessment typically occurs between two and a half to three years old, once children can respond naturally. A speech therapist evaluates the results, categorizing them as adequate, marginal, or at risk.
In these cases, speech therapy or monitoring is recommended. If speech closure remains incomplete after further evaluation, surgery is advised. A nasopharyngeal endoscopy is then performed to assess the soft palate and posterior pharyngeal area.
The optimal window for language development and evaluation is between ages three and five. If surgery is deemed necessary, it should occur before age five.
Two main types of voice correction surgery exist: Furlow's Z-plasty and pharyngeal flap surgery.
Furlow's Z-plasty uses a similar technique to some cleft palate repairs but focuses on tightening the muscles in the soft palate.
The choice between procedures depends on a nasopharyngeal endoscopy, which measures the degree of closure in the soft palate and posterior pharyngeal area. Scores range from 0 to 1, with lower scores indicating incomplete closure.
Furlow's Z-plasty revisits the original surgical site to re-tighten muscles. Pharyngeal flap surgery involves taking tissue from the posterior pharyngeal wall and suturing it to strengthen the connection between the soft palate and posterior pharyngeal wall.
Normal speech relies on complete closure between the soft palate and posterior pharyngeal wall to prevent nasal sounds.
Voice correction surgery aims to improve the seal between the soft palate and posterior pharyngeal wall. However, this can narrow the airway, potentially leading to snoring or noisy breathing.
After cleft palate surgery, some parents notice their child snoring due to a narrower airway. This is often a sign of successful surgery, but outcomes vary by individual anatomy. Breathing difficulties are common in the first three months post-surgery due to swelling but usually resolve afterward.
For voice correction surgery, performed on children over three, airway narrowing is milder, yet noisy breathing may occur during the initial swelling period.