<p>Cleft lip and palate (CLP) is a congenital malformation. Assessment, care-planning and treatment in Sweden is executed by a team at six major regional hospitals. Historically, CLP-treatment has undergone many changes. The aim of this study is to map out how CLP-treatment regime has developed in Linköping and Stockholm during, primarily the second half of the 20th century. The focus of the study is on surgery, speech therapy and orthodontic treatment.</p><p>A study of medical records was conducted of 89 records at the speech-care unit at Linköping University hospital. The different types of clefts included were unilateral and bilateral CLP (UCLP, BCLP) and isolated cleft palate in patients born between 1908 and 1995. Interviews were made with a phoniatrician, a dental orthopaedist and a speech and language pathologist with long experience in CLP-patient care.</p><p>Results showed, that the total number of operations generally decreased for patients with BCLP and isolated cleft palate. The age when operations were performed varied less after 1975. Time in hospital for surgery became more stable and shorter. The age at the first speech therapy session decreased during the 20th century and the number of sessions at Linköping University hospital decreased for patients born after 1970.</p><p>The conclusions of this study are:</p><p>● age when operating has become more stable.</p><p>● time in hospital for surgery has decreased.</p><p>● number of treatments, both operations and speech therapy sessions, has decreased.</p> / <p>Läpp-, käk- och gomspalt (LKG) är en medfödd missbildning. Behandling och planering av vård för patienter i Sverige med denna missbildning utförs av specialistteam vid sex av landets stora sjukhus. Vården av personer med LKG har historiskt genomgått förändringar. Syftet med föreliggande studie är att kartlägga hur LKG vården utvecklats i Linköping och Stockholm, främst under senare hälften av 1900-talet. Studien fokuserar på kirurgi, talbehandling och ortodontisk behandling.</p><p>En journalstudie genomfördes av 89 journaler från Talvårdsavdelningen vid Linköpings Universitetssjukhus. Spalttyperna som ingick i studien var unilateral och bilateral total spalt (U-LKG, B-LKG) samt isolerad gomspalt. Patienterna var födda mellan 1908 och 1995. Intervjuer gjordes med en foniater, en käkortoped och en logoped, som samtliga under flera år var involverade i omhändertagandet av patienter med LKG.</p><p>I studien framkom att det totala antalet operationstillfällen generellt har minskat för B-LKG och isolerad gomspalt. Sedan 1975 har åldern vid operationerna varierat mindre mellan åren. Även vårdtiderna vid operationerna har stabiliserats samt blivit allt kortare. Åldern vid första talbehandlingen har generellt sjunkit under 1900-talet och antalet talbehandlingar på sjukhuset i Linköping har sjunkit för patienter födda efter 1970.</p><p>Slutsatser som kan dras av föreliggande studie är att:</p><p>● tidpunkterna för operationer har blivit mer stabila.</p><p>● vårdtiderna vid operationer har blivit kortare.</p><p>● antalet behandlingar, såväl operationer som talbehandlingar, har minskat.</p>

Cleft lip and palate (CLP) is a congenital malformation. Assessment, care-planning and treatment in Sweden is executed by a team at six major regional hospitals. Historically, CLP-treatment has undergone many changes. The aim of this study is to map out how CLP-treatment regime has developed in Linköping and Stockholm during, primarily the second half of the 20th century. The focus of the study is on surgery, speech therapy and orthodontic treatment. A study of medical records was conducted of 89 records at the speech-care unit at Linköping University hospital. The different types of clefts included were unilateral and bilateral CLP (UCLP, BCLP) and isolated cleft palate in patients born between 1908 and 1995. Interviews were made with a phoniatrician, a dental orthopaedist and a speech and language pathologist with long experience in CLP-patient care. Results showed, that the total number of operations generally decreased for patients with BCLP and isolated cleft palate. The age when operations were performed varied less after 1975. Time in hospital for surgery became more stable and shorter. The age at the first speech therapy session decreased during the 20th century and the number of sessions at Linköping University hospital decreased for patients born after 1970. The conclusions of this study are: ● age when operating has become more stable. ● time in hospital for surgery has decreased. ● number of treatments, both operations and speech therapy sessions, has decreased. / Läpp-, käk- och gomspalt (LKG) är en medfödd missbildning. Behandling och planering av vård för patienter i Sverige med denna missbildning utförs av specialistteam vid sex av landets stora sjukhus. Vården av personer med LKG har historiskt genomgått förändringar. Syftet med föreliggande studie är att kartlägga hur LKG vården utvecklats i Linköping och Stockholm, främst under senare hälften av 1900-talet. Studien fokuserar på kirurgi, talbehandling och ortodontisk behandling. En journalstudie genomfördes av 89 journaler från Talvårdsavdelningen vid Linköpings Universitetssjukhus. Spalttyperna som ingick i studien var unilateral och bilateral total spalt (U-LKG, B-LKG) samt isolerad gomspalt. Patienterna var födda mellan 1908 och 1995. Intervjuer gjordes med en foniater, en käkortoped och en logoped, som samtliga under flera år var involverade i omhändertagandet av patienter med LKG. I studien framkom att det totala antalet operationstillfällen generellt har minskat för B-LKG och isolerad gomspalt. Sedan 1975 har åldern vid operationerna varierat mindre mellan åren. Även vårdtiderna vid operationerna har stabiliserats samt blivit allt kortare. Åldern vid första talbehandlingen har generellt sjunkit under 1900-talet och antalet talbehandlingar på sjukhuset i Linköping har sjunkit för patienter födda efter 1970. Slutsatser som kan dras av föreliggande studie är att: ● tidpunkterna för operationer har blivit mer stabila. ● vårdtiderna vid operationer har blivit kortare. ● antalet behandlingar, såväl operationer som talbehandlingar, har minskat.

Syfte: Syftet med den här studien var att kartlägga upplevelsen av omhändertagandet bland föräldrar till LKG-patienter och unga vuxna LKG-patienter i södra Sverige. Material och metod: Samtliga av de artiklar som presenteras i den här rapporten har erhållits genom litteratursökning på PubMed. Främst användes artiklar som berör upplevelsen av omhändertagandet, men även litteratur och hemsidor från svenska sjukhus och LKG-föreningar bidrog med information. För djupare förståelse av och för att erhålla ytterligare information om omhändertagandet i södra Sverige utfördes även en intervju med Ingemar Swanholm, ortodontist vid SUS. I denna enkätstudie tillfrågades 55 personer, varav 24 var föräldrar till barn med LKG och 31 var unga vuxna LKG-patienter. Detta gjordes för att få en helhetsbild av hur patienter och föräldrar upplevt omhändertagandet genom behandlingsgången.Resultat: Totalt deltog 30 patienter, varav 13 föräldrar till barn med LKG och 17 unga vuxna LKG-patienter. Resultatet redovisades var för sig, föräldrars upplevelse respektive patientens egen.Konklusion: Konklusion var att LKG-patienter och föräldrar till barn med LKG generellt var nöjda med omhändertagandet av dem och deras familj, vilket bekräftade hypotesen. För att kunna dra en slutgiltig slutsats om detta krävs dock vidare undersökningar med fler deltagande och validerade enkäter.

Complete bilateral cleft lip and palate are one of the most severe forms of orofacial deformities. This is why their rehabilitation represents a special challenge to the interdisciplinary treatment team. The ideal procedure of treatment is still today an object of controversial discussions and the aim of many investigations. Especially the right moment for the repair of the hard palate is disputed. Thereby an undisturbed development of speech contrasts to an inhibition of growth because of resulting scar tissue. To evaluate the advantages and disadvantages of several treatment concepts the analysis of plaster models has been proved to be a suitable method. In this study the maxillary morphology of cleft patients with deciduous dentition was analysed following the investigations of KRAUSE (2005) that are concerning the infant situation. Thereby it was focused on the vertical development to which item only a few studies exist until now. The patients were treated following two different concepts with early or late closure of the palate respectively, which were compared. Additionally a comparison to a group of non cleft children was made. The group of investigation derived from the archive of the “Zentrum für Mund-, Kiefer-, Gesichtschirurgie” of the University of Leipzig including models of 16 patients at the average age of 4 years and 2 months of it. The therapy of all patients was done according to the same concept which included a similar closure of the lip at an average age of 5 months after an early orthodontic treatment according to HOTZ. The closure of the palate took place at the age of 10 up to 14 which was long before the time of investigation. They were compared to a reference group of 21 cleft patients of the former “Wolfgang-Rosenthal-Klinik” in Thallwitz. The average age in this group was 4 years and 8 months. These patients underwent the same procedure as well without an orthodontic treatment and with a two-phase lip closure at the age between 4 and 6 months. The repair of the palate was made only after our point of investigation. The control group of non cleft children finally originated in a collection of the former head of the orthodontic and prosthetic compartment of the University of Leipzig Prof. Dr. Kleeberg including models of 34 patients. Also these subjects had a complete deciduous dentition. However, the exact age could not be determined. All plaster casts were measured three-dimensionally with the reflex-microscope. As reference points served special points of the mucosal surface defined by ASHLEY-MONTAGU and SILLMAN as well as by MAZAHERI. To enable vertical measurements a plane of reference was constructed with the help of the tuberosity points and the half intercanine distance. The results showed clear differences between the two cleft groups as well as to the non cleft control group. Thereby it had to be discriminated between the results of the orthodontic treatment and the lip closure and those caused by the early or late repair of the palate respectively. Considering the vertical development especially the latter became obvious. So the segmental ends of the reference group showed a more pronounced cranial collapse than those of the group of investigation what is probably due to the late closure of the palate. However the premaxilla of the group of investigation was obviously more caudal situated so the incisal point showed a significant difference to the non cleft controls. On the contrary there were greater differences within the reference group regarding the vertical position of the premaxilla which was also more rotated than in the group of investigation. Probably because of the two-phase lip closure the right end of the premaxilla was more cranial located so the vertical distance between the alveolar segment and the premaxilla was greater on the left side. Furthermore the incisal point showed a greater deviation from the midline than it was in the group of investigation what is probably also due to the two-phase lip closure. The smallest deviation from the midline was found in the control group. In transversal direction there was a similar unfavorable relation between anterior and posterior arch width in both cleft groups, what became obvious with a significant smaller segmental angle than it was in the non cleft group. This was caused by a significant smaller anterior arch width in the group of investigation whereas the posterior arch width was almost normal. This was probably due to the early orthodontic treatment and the simultaneous lip closure as well as to the early palatal closure. In contrast the anterior arch width of the reference group showed hardly any differences but the posterior width was significant greater than in the control group. This development may have been caused by the late palatal repair allowing an unimpeded growth to take place. Finally the evaluation of the sagittal relations revealed a greater arch length in the cleft groups than in the control group. The greatest distance became again obvious in the reference group. For this difference was already measured in infancy one can presume that the closure of palate did not have a great influence on that development but the orthodontic treatment did. In summary it can be concluded that the time of palatal closure is mainly relevant concerning the vertical development but also in regard of the intertuberosity width. Thus the results of this study suggest a more favorable effect of an early closure of the palate. To verify these results further studies especially after palatal closure in the reference group are necessary. Furthermore a vertical measurement related to the cranium would be suitable.

Syfte:  Syftet med föreliggande översiktsstudie, med fokus på käk- och gomspalt, är att identifiera vilka behandlingsalternativ där tandteknikern inkluderas i LKG (Läpp-, Käk- och Gomspalt)-teamet det finns och vilka av behandlingsalternativen som är att föredra utifrån ansiktsestetik och funktion (äta, andning och tal). Material &amp; metod: Systematiska litteraturstudier granskades utifrån PICO-systemet och sökning i databasen PubMed. Resultat: Endast en artikel funnen i PubMed, uppfyllde urvalskriterierna. Denna artikel inkluderade 20 studier i sin analys, där 3 av dem var mest unika. Från dessa 3 studier kunde en och samma patientens behandling från 2 veckor till 12 år följas. Översiktsstudien gav värdefull information om funktion (tal), estetik, livskvalité och utveckling (längd och språk) samt psykosociala konsekvenser. Analys baserat på de 20 studierna visar att användningen av ortodontisk apparatur inte gett någon större skillnad om apparaturen användes eller ej. Slutsats: Det är oklart vilka behandlingsalternativ som är att föredra för behandling av käk- och gomspalt utifrån ansiktsestetik och funktion. Olika apparaturer kan ge olika resultat, dock kan man inte se någon skillnad på slutresultatet baserat på om en patient använder ortodontisk apparatur eller inte. För att få tydligare svar på frågeställningen behövs ytterligare forskning göras, med flera kliniska uppföljningsstudier som kan resultera i en bättre behandlingsplan för den individuella patienten. / Purpose: The purpose of this overview study, focusing on the cleft of the jaw and palate, is to identify which treatment options that are available where the dental technician is included in the CLP team and which of the treatment options are preferable based on facial aesthetics and function (eating, breathing and speaking). Material &amp; method: An overview was done of systematic reviews based on the PICO-system and searching PubMed database. Results: Only one systematic review was included from PubMed which met the selection criteria. This article included 20 studies, where 3 of them were most unique. From these 3 studies, patient treatment from 2 weeks to 12 years could be followed. This systematic review article provided valuable information on function (speech), aesthetics, quality of life and development (length and language) as well as psychosocial consequences. Analysis based on the 20 studies shows that the use of orthodontic appliances made no major difference whether they were used or not. Conclusion: It is unclear which treatment alternatives that are preferable for the treatment of cleft of the jaw and palate based on facial aesthetics and function.  Different constructions can give different results, however, one cannot see any difference in the treatment outcome based on whether a patient had used an orthodontic appliance or not. Further research including more clinical follow-up studies needs to be done to get clear answers of the research question and with evidence available, resulting in a better treatment plan for the individual patient.

Velofarynxinsufficiens (VFI) innebär en nedsatt förmåga att under tal och födointag stänga till mellan mun- och näshåla vilket leder till ett avvikande tal. Operation med svalglambå är en metod som kan användas för att behandla VFI och tidigare forskning har visat goda resultat avseende dess effekt på talet. Dock menar vissa forskare att operationen kan ha negativa effekter och att den bakomliggande orsaken till insufficiensen kan påverka graden av framgång. Aktuell studie ämnade undersöka huruvida operation med svalglambå påverkade talet vid VFI samt belysa om några skillnader fanns mellan olika patientgrupper avseende operationens effekt på tal. De olika patientgrupperna var (a) patienter med spalt, (b) patienter med spalt i kombination med ett syndrom eller en sekvens och (c) patienter med VFI utan förekomst av spalt. Eftersom tidigare studier dessutom indikerat att postoperativ talbehandling hos logoped kan vara relevant för vissa patienter undersöktes det också under vilka omständigheter det skedde. Journaler, inklusive perceptuella lyssnarbedömningar av talet genomförda av logopeder, och enkätsvar studerades för de 66 patienter som deltog. Dessa utgjorde 43,1% av alla 153 patienter som genomgått operation med svalglambå på Akademiska sjukhuset i Uppsala år 2000-2011. Talbedömningar genomförda före och ett år efter operation visade att talet förbättrades avseende förståelighet (p&lt;0,001), hypernasalitet (p=0,005) och tryckreducerad artikulation (p=0,001) samtidigt som hyponasalitet inte ökade (p=0,55). Patienter med spalt i kombination med syndrom eller sekvens uppvisade större förbättring av hypernasalitet jämfört med de andra grupperna (p=0,037). 32 patienter gick i postoperativ talbehandling hos logoped och patienter med enbart spalt fick behandling i något högre utsträckning än patienter med gomspalt i kombination med syndrom eller sekvens. Kompensatorisk artikulation var den enda talavvikelsen vars förekomst kunde relateras till att patienten gick i postoperativ talbehandling. Resultaten indikerar att operation med svalglambå är en lämplig metod för att behandla VFI oavsett bakomliggande orsak. Nyckelord: Velofarynxinsufficiens, svalglambå, LKG, syndrom, primär VFI, talavvikelse, talbehandling / Velopharyngeal insufficiency (VPI) refers to the failure of separating the oral cavity from the nasal cavity during speech and deglutination. This leads to increased airflow through the nose and is the cause of resonance disturbances such as hypernasality and nasal emission. Previous studies evaluating the success of pharyngeal flap surgery to treat VPI have indicated satisfying result although some studies stress side effects due to postoperative constrictions. The underlying cause of VPI has been shown to influence the postoperative result. With this background we investigated the differences in speech, pre-, and one year post pharyngeal flap surgery and compared the three groups (a) cleft palate, (b) cleft palate in combination with a syndrome or a sequence, and (c) VPI without cleft palate. We also investigated the co-occurance of postoperative speech therapy regarding different speech parameters and the underlying cause of VPI. 66 of the 153 patients who underwent a pharyngeal flap surgery at Akademiska sjukhuset in Uppsala 2000-2011 agreed to participate in the study. 32 patients attended postoperative speech therapy. The data was collected through medical records and a survey and included perceptual analyses of speech pre-, and post surgery performed by speech and language pathologists. According to the results from the perceptual assessment, the pharyngeal flap surgery resulted in improved speech; intelligibility (p&lt;0.001), hypernasality (p=0.005) and weak consonant pressure (p=0.001). Hyponasality did not increase significantly (p=0.55). Patients with cleft palate in combination with a syndrome or a sequence showed greater improvement regarding hypernasality (p=0.037). The only speech disturbance co-occurring with the presence of postoperative speech therapy was compensatory articulation. Patients with cleft palate seemed to receive postoperative speech therapy in a higher extent than patients with cleft palate in combination with a syndrome or a sequence. These results indicate that pharyngeal flap surgery is a successful way of treating VPI disregarding underlying cause. Keywords: Velopharyngeal insufficiency, pharyngeal flap, cleft palate, syndrome, primary VPI, speech deviation, speech therapy

Läpp-, käk och gomspalt (LKG) kan medföra svårigheter med tal, artikulation och röst. Enligt tidigare forskning har vuxna individer behandlade för LKG liknande förekomst av röstavvikelser som kontrollpersoner utan spalt. Syftet med denna studie var att undersöka grad av röstavvikelser hos vuxna patienter behandlade för enkelsidig LKG och kartlägga eventuella samband mellan röstavvikelser och kirurgiska metoder för gomslutning, kön och operation med eller utan svalglambå samt jämföra röstresultat med data från individer utan LKG. Sjuttio patienter behandlade för enkelsidig genomgående LKG deltog i studien, varav 45 patienter hade opererats med gomslutning i en seans och 25 patienter hade opererats i två seanser. Elva av patienterna i patientgruppen hade genomgått svalglambåoperation. I studien ingick även en åldersmatchad kontrollgrupp med 63 individer utan LKG. Röstinspelningar utvärderades med perceptuell röstbedömning med Stockholm Voice Evaluation Approach (SVEA) av två erfarna logopeder. Skattning skedde individuellt av randomiserade och blindade inspelningar. Inter- och intrabedömarreliabilitet beräknades. Grad av avvikelse i röstkvalité var ca. 5/100 i patientgrupp och kontrollgrupp vilket är lägre jämfört med tidigare studier. “Knarr” fanns lägre i patientgruppen i jämförelse med kontrollgrupp. Skattningar av övriga röstparametrar skiljde sig inte mellan patientgrupp och kontrollgrupp. Patienter opererade med gomslutning i en eller två seanser hade inga skillnader i röstparametrar. Enstaka små skillnader fanns mellan könen. Ingen skillnad fanns mellan patienter som genomgått svalglambåoperation och de som inte gjort det. / Cleft lip and palate (CLP) may cause impairments in speech, articulation and voice. Treatment of patients with CLP include different types of palatoplasty. Recent studies have found a comparable prevalence rate of dysphonia in adult patients treated for CLP and controls without cleft. The purpose of this study was to investigate the rate of dysphonic deviation in adult patients treated for unilateral CLP and determine, if any, the relationship between voice quality outcome and differences in surgical procedures, gender, palatoplasty with or without pharyngeal flap surgery and compare the voice characteristics with age related normative data. Seventy patients treated for unilateral CLP with one- or two-stage palatoplasty participated in this study, of which 45 patientshad undergone one-stage palatoplasty and 25 patients two-stage palatoplasty. Eleven ofthe patients had also undergone pharyngeal flap surgery. Data from an age matched non-cleft group consisted of 63 participants. Sound recordings of participants' voices were perceptually assessed by two speech-language pathologists. Individual ratings of randomized and blinded sound recordings were performed. Inter- and intra-raterreliability was calculated. The study showed a lower degree of dysphonia in patients treated for unilateral CLP than earlier studies. Among patients treated for unilateral CLP and the non-cleft group, a degree of approximately 5/100 voice quality deviation was found. ”Vocal fry” was found significantly lower in patients treated for CLP than the non-cleft group. Measures of voice parameters did not differ significantly between patients and non-cleft groups. Patients that had undergone palatoplasty in one or two stages showed no significant differences in voice parameters. Minor statistical significance was found in a few of the measured voice parameters as related to gender. Between patients that had undergone pharyngeal flap surgery and those that had not no differences were found.

Complete bilateral cleft lip and palate are one of the most severe forms of orofacial deformities. This is why their rehabilitation represents a special challenge to the interdisciplinary treatment team. The ideal procedure of treatment is still today an object of controversial discussions and the aim of many investigations. Especially the right moment for the repair of the hard palate is disputed. Thereby an undisturbed development of speech contrasts to an inhibition of growth because of resulting scar tissue. To evaluate the advantages and disadvantages of several treatment concepts the analysis of plaster models has been proved to be a suitable method. In this study the maxillary morphology of cleft patients with deciduous dentition was analysed following the investigations of KRAUSE (2005) that are concerning the infant situation. Thereby it was focused on the vertical development to which item only a few studies exist until now. The patients were treated following two different concepts with early or late closure of the palate respectively, which were compared. Additionally a comparison to a group of non cleft children was made. The group of investigation derived from the archive of the “Zentrum für Mund-, Kiefer-, Gesichtschirurgie” of the University of Leipzig including models of 16 patients at the average age of 4 years and 2 months of it. The therapy of all patients was done according to the same concept which included a similar closure of the lip at an average age of 5 months after an early orthodontic treatment according to HOTZ. The closure of the palate took place at the age of 10 up to 14 which was long before the time of investigation. They were compared to a reference group of 21 cleft patients of the former “Wolfgang-Rosenthal-Klinik” in Thallwitz. The average age in this group was 4 years and 8 months. These patients underwent the same procedure as well without an orthodontic treatment and with a two-phase lip closure at the age between 4 and 6 months. The repair of the palate was made only after our point of investigation. The control group of non cleft children finally originated in a collection of the former head of the orthodontic and prosthetic compartment of the University of Leipzig Prof. Dr. Kleeberg including models of 34 patients. Also these subjects had a complete deciduous dentition. However, the exact age could not be determined. All plaster casts were measured three-dimensionally with the reflex-microscope. As reference points served special points of the mucosal surface defined by ASHLEY-MONTAGU and SILLMAN as well as by MAZAHERI. To enable vertical measurements a plane of reference was constructed with the help of the tuberosity points and the half intercanine distance. The results showed clear differences between the two cleft groups as well as to the non cleft control group. Thereby it had to be discriminated between the results of the orthodontic treatment and the lip closure and those caused by the early or late repair of the palate respectively. Considering the vertical development especially the latter became obvious. So the segmental ends of the reference group showed a more pronounced cranial collapse than those of the group of investigation what is probably due to the late closure of the palate. However the premaxilla of the group of investigation was obviously more caudal situated so the incisal point showed a significant difference to the non cleft controls. On the contrary there were greater differences within the reference group regarding the vertical position of the premaxilla which was also more rotated than in the group of investigation. Probably because of the two-phase lip closure the right end of the premaxilla was more cranial located so the vertical distance between the alveolar segment and the premaxilla was greater on the left side. Furthermore the incisal point showed a greater deviation from the midline than it was in the group of investigation what is probably also due to the two-phase lip closure. The smallest deviation from the midline was found in the control group. In transversal direction there was a similar unfavorable relation between anterior and posterior arch width in both cleft groups, what became obvious with a significant smaller segmental angle than it was in the non cleft group. This was caused by a significant smaller anterior arch width in the group of investigation whereas the posterior arch width was almost normal. This was probably due to the early orthodontic treatment and the simultaneous lip closure as well as to the early palatal closure. In contrast the anterior arch width of the reference group showed hardly any differences but the posterior width was significant greater than in the control group. This development may have been caused by the late palatal repair allowing an unimpeded growth to take place. Finally the evaluation of the sagittal relations revealed a greater arch length in the cleft groups than in the control group. The greatest distance became again obvious in the reference group. For this difference was already measured in infancy one can presume that the closure of palate did not have a great influence on that development but the orthodontic treatment did. In summary it can be concluded that the time of palatal closure is mainly relevant concerning the vertical development but also in regard of the intertuberosity width. Thus the results of this study suggest a more favorable effect of an early closure of the palate. To verify these results further studies especially after palatal closure in the reference group are necessary. Furthermore a vertical measurement related to the cranium would be suitable.

Bereits in frühen Phasen der Sprachentwicklung sind bei Kindern mit Spaltbildungen im Vergleich zu Kindern ohne Spaltbildungen Abweichungen beobachtet worden. In der Fachliteratur sind allerdings meist nur undifferenzierte Aussagen über den frühen strukturellen Verlauf zu finden. Daher wurde eine Untersuchung an 100 Kindern mit Spaltbildungen im Alter von 0-1;6 Jahren durchgeführt. Untersuchungsgegenstand waren die kindlichen Vokalisationen in der 1.Lallphase, der 2.Lallphase (prälinguistische Phase) und der Phase des Sprechbeginns (frühe linguistische Phase). Die Analyse umfaßte phonetische Parameter, den aktiven Wortschatz sowie die Silben- und Wortstrukturen. Die Auswertung ergab hinsichtlich des temporalen Verlaufs beim überwiegenden Teil der Probanden keine Unterschiede, hinsichtlich des strukturellen Verlaufs jedoch deutliche, typisch-spezifische Unterschiede im Vergleich zu altersgleichen Kindern ohne Spaltbildungen. / Even at the earliest stages, differences in speech development can be observed between children with cleft palate and those without cleft palate. One finds, however, only undifferentiated statements in the scientific literature on the early structural and linguistic phases. We therefore undertook an investigation of 100 children with cleft palate between the ages of 0 and 1;6 years. The subjects of the investigation were the children s vocalizations during the first and second babbling phases (prelinguistic phase) and during the onset of speech (early linguistic phase). The analysis included phonetic parameters and active vocabulary, as well as syllable and word structures. Our results showed no differences among the majority of the cildren, in terms of temporal development, and only typical-specific differences in structural development, in comparison with children of the same age without cleft palate.

Bereits im frühen Kindesalter zeigen Kinder mit Spaltbildungen im Vergleich zu Kindern ohne Spaltbildungen eine veränderte Sprachentwicklung. Untersucht wurden die Möglichkeiten einer von Geburt ansetzenden Sprachförderung von Kindern mit Spaltbildung unter intensiver Zusammenarbeit mit den Eltern im Hinblick auf eine physiologische Sprachentwicklung. Innerhalb der Arbeit wurde ein sprachliches Frühförderkonzept für Kinder mit Lippen-, Kiefer-, Gaumenspalte (LKG) für die Zeit der ersten zwei Lebensjahre entwickelt und mit sieben Kindern mit LKG (Untersuchungsgruppe) in Form von Hausbesuchen erprobt. Im Alter von zwei Jahren wurde die Sprachentwicklung dieser Kinder mit sieben Kindern ohne Spaltbildung (Vergleichsgruppe) verglichen. Für die Auswertung der Untersuchungen kamen die Testverfahren ELFRA-1, ELFRA-2 und SETK-2 sowie eine informelle Prüfung des Lautbestandes zum Einsatz. Die Ergebnisse bestätigten bei fünf Kindern der Untersuchungsgruppe Unterschiede im sprachlichen Entwicklungsverlauf, die sich in Tendenzen zu Sprachentwicklungsrückständen bzw. Auffälligkeiten auf phonetisch-phonologischer Ebene niederschlugen. Deutlichere Hinweise auf Symptome der Gaumenspaltensprache gab es nur bei zwei Probanden. Zwei Kinder der Untersuchungsgruppe zeigten eine altersgerechte sprachliche Entwicklung. Möglicherweise sind diese positiven Ergebnisse auch auf die frühe sprachtherapeutische Förderung zurückzuführen. Zukünftig müsste die Wirksamkeit frühsprachlicher Förderkonzepte anhand von größeren Probandengruppen und längerem Förderzeitraum untersucht werden. / Even in the earliest stages of speech and language development children with cleft lip and palate show differences compared to children without clefts. This study focussed on encouraging early speech development of children with cleft lip and palate and investigated an intensive cooperation between speech pathologist and parents straight after birth up to the age of two years. An early intervention speech program was developed for the first two years of life and tried out on seven children with cleft lip and palate (research group). At the age of two the speech and language development of these children was compared to seven children without clefts (control group). For the time of the investigation the speech pathologist visited the families at home on a regular basis. Evaluation was done with the help of the following instruments: parent questionnaire ELFRA-1, ELFRA-2, language test SETK-2 and an informal screening of the childrens’ sound inventory. The results show differences in speech development in five children with clefts that are reflected in tendencies for delayed speech development and decreased phonological abilities. However, only two children of the research group showed distinctive signs of cleft palate speech. Two children of this group even had speech and language outcomes without pathological findings. Tentatively, these positive results may also be attributed to the effects of the early speech intervention. In future, the effectivity of such programs must be evaluated by researching larger groups of children over a longer period of time.