No description available.

Background: The management of cleft lip and/or palate (CL/P) includes multidisciplinary care beginning in infancy and continuing through to adulthood. Outcomes of cleft care have been difficult to measure because of the subjective nature of evaluating concepts such as appearance and speech. Including the patient perspective in outcome evaluation through the use of a patient-reported outcome (PRO) measure would provide a more accurate reflection of a patient’s status. The overall objective of this thesis is to show that through adherence to rigorous methods of development, a PRO measure can provide clinically meaningful outcome evaluation in cleft care. Methods: The first paper uses the qualitative method of interpretive description to define a conceptual framework to guide the development of a PRO measure for patients with CL/P, the CLEFT-Q. The second paper describes the protocol for the entire development of the CLEFT-Q. The third paper analyzes the results of the cross-sectional field-test of the CLEFT-Q scales to determine whether or not the CLEFT-Q is able to detect differences between specific cleft types. Results: The qualitative study included 138 patients with CL/P from six countries. The final conceptual framework contained thirteen concepts within the domains of appearance, facial function, and health-related quality of life. The second paper details the process of designing the CLEFT-Q scales. The field-test included 2,434 patients from thirty sites in twelve countries, and CLEFT-Q scores were found to vary with cleft type for all scales. Conclusions: PRO measures need to be rigorously designed in order to provide scientifically sound, clinically meaningful measurement. The CLEFT-Q is able to detect differences between patients with various cleft types, and will be a useful tool to provide the patient perspective in future outcome evaluation in cleft care. / Thesis / Doctor of Philosophy (PhD) / Measuring outcomes of treatment for cleft lip and/or palate (CL/P) should include the patient perspective. The objective of this thesis is to show that through rigorous methods of development, a patient-reported outcome (PRO) measure, the CLEFT-Q, can provide clinically meaningful evaluation of outcomes. First, 136 patients with CL/P from six countries were interviewed to learn what concepts related to having a cleft or its treatment are important to them. A conceptual framework was developed that informed the CLEFT-Q scales. Describing the methodology behind developing the CLEFT-Q then served to inform and engage members of the community. A field-test of the CLEFT-Q scales showed that in a sample of 2,434 patients with CL/P from twelve countries, CLEFT-Q outcomes varied in patients with different types of CL/P. The CLEFT-Q can be used to provide rigorous measurement of PROs in patients with CL/P in the future.

published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

In mainland China, around 20,000 infants with non-syndromic cleft lip and/or palate are born every year. There is a great clinical need for the rigorous investigation of the speech problems in this population. This thesis aimed to investigate the consonant misarticulations in native Putonghua speakers with repaired cleft palate based on a research project comprised of four studies. Misarticulations associated with cleft palate are well established for English and several other Indo-European languages. However, few research articles describing the articulation of Putonghua (standard Mandarin Chinese) speakers with cleft palate have been published in English language journals. Study One reviewed relevant studies published over the past 30 years in Chinese language journals. Thirty-seven articles were analyzed and coded on a number of methodological variables. This critical review identified many methodological issues. These design flaws made it difficult to draw reliable conclusions about characteristic articulation errors. Seeing the methodological shortcomings found in Study One, a cross-sectional approach was used in Study Two to identify common consonant error patterns. Thirty-two speakers with repaired cleft palate were allocated to four groups dependent on age and the type of cleft. Articulation was evaluated based on the Putonghua Segmental Phonology Test and the Deep Test for Cleft Palate Speakers in Putonghua. The data were transcribed using International Phonetic Alphabet conventions by two experienced examiners. Several ‘language universal’ findings were identified. In addition, distinctive features in Putonghua phonology appeared to contribute to the observed language specific error patterns. The following two studies focused on the particularly vulnerable manner of articulation: affricates. The results from Study Three showed that distorted affricates from speakers with repaired cleft palate exhibited distinctive spectral features compared to typical articulation. These spectral findings added objective evidence to support the articulation deviation noted in Study Two. Study Four examined the relationship between spectral moments and perceptual judgment of accuracy for the place of affricate and to explore whether listeners relied on different spectral moments to perceive place of articulation. Both typical and distorted affricates were played to twelve listeners to make a judgment of articulation accuracy using visual analog scaling. Results showed that the third spectral moment (L3) was significantly correlated with perceptual rating of accuracy of place information from typical speakers. For affricates produced by speakers with cleft palate, the first moment (M1) showed a significantly correlation with perceptual judgment of the accuracy of alveolar affricates. Recommendations concerning methodological issues in the perceptual investigation of cleft palate speech were given in the systematic review. For the first time, the speech error study demonstrated the influence of language-specific features on Putonghua cleft palate speech. The spectral study contributed to our understanding of the differences in affricate production between speakers with cleft and their typical speaking peers. The investigation of the relationship between spectral features and the perception of alveolar and retroflex affricates provided specific clinical directions for establishing the correct place of articulation. Further research is needed to explore the contribution of other variables (e.g., age of palatoplasty) to the error patterns identified in the present study. / published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

No description available.

MSc, Plastic and Reconstructive Surgery, Faculty of Health Sciences, University of the Witwatersrand / Evolution of cleft lip repair has been ongoing for many years. The reason for the various techniques stems from the advances relevant to function and aesthetics of the repair. Unfortunately, the literature does not reveal the long term results of many of these procedures with reference to normal lip anthropometrics. The reason for this is that the normal lip anthropometrics have not been adequately described. This study aims to describe a new technique for unilateral cleft lip repair and to substantiate its evolution by comparing it to the normal upper lips as well as to the most popular current technique of cleft lip repair (Millard technique). This will be done by the following steps: 1. Evaluate the most commonly used current technique of unilateral cleft lip repair (Millard rotation advancement), both objectively and subjectively. 2. Assess the normal anthropometric measurements of the horizontal lip dimensions. a. To assess normal horizontal lip dimensions according to different age categories to serve as reference values for further studies. b. To assess the timing where the lip is fully developed. vi c. To assess Cupid’s bow length in relation to horizontal lip length at different ages, thereby assessing dynamic changes with growth. 3. Compare the currently used technique of unilateral cleft lip repair to normal values indicating the anatomical drawbacks to the technique. 4. Describe a new technique for unilateral cleft lip repair which eliminates some of the unwanted drawbacks of the Millard technique. This new technique has the distinct advantage of maintaining better lip symmetry and not breaching anatomical landmarks of the lip. This technique is referred to as the straight line repair and is easy to teach and the results are reproducible

No description available.

Background: Several treatment protocols exist for the management of patients with complete unilateral (CUCLP) and bilateral (CBCLP) cleft lip and palate, and little evidence exists on comparison of their outcomes. Objectives: To compare craniofacial morphology among individuals with CUCLP and CBCLP treated at different North American centers. Methods: Lateral cephalograms of 148 individuals with repaired CUCLP (average age = 8y 8m) and 93 individuals with repaired CBCLP (average age = 8y 10m) were analyzed. The group means for the different centers per cephalometric measurement evaluated (16 angular, 7 linear, and 2 ratio), were compared using ANOVA. Results: For both the CUCLP and CBCLP samples, the most significant differences were observed in the sagittal maxillary prominence. The center that performed primary alveolar bone grafting consistently showed the lowest maxillary prominence. Conclusions: Significant differences in craniofacial morphology, specifically maxillary prominence, exist among patients with CUCLP and CBCLP treated at different North American centers.

Cleft lip and/or palate is a craniofacial condition that can lead to complex speech disorders. In particular, the auditory-perceptual speech assessments of individuals with cleft palate can be difficult because cleft-type compensatory articulations may be outside of English phonology. Therefore, it is desirable to supplement auditory-perceptual assessments with instrumental measurements. In the first study, thirteen participants with cleft-type compensatory articulations completed ultrasound speech exams. The stimuli were repeated VCV combinations (target consonants: [t], [k], [s], [sh], [n], [ng]; vowel contexts: [a], [i], [u]). Ultrasound imaging confirmed auditory-perceptual impressions and revealed covert articulatory movements. In the second study, six participants were assessed after a course of speech therapy. Outcomes were recorded on a severity metric with categories describing auditory-perceptual and motor aspects of speech errors. The severity metric quantified the incremental changes in both dimensions. Based on the research presented, further investigations of cleft palate speech using ultrasound are warranted.

Background: Several treatment protocols exist for the management of patients with complete unilateral (CUCLP) and bilateral (CBCLP) cleft lip and palate, and little evidence exists on comparison of their outcomes. Objectives: To compare craniofacial morphology among individuals with CUCLP and CBCLP treated at different North American centers. Methods: Lateral cephalograms of 148 individuals with repaired CUCLP (average age = 8y 8m) and 93 individuals with repaired CBCLP (average age = 8y 10m) were analyzed. The group means for the different centers per cephalometric measurement evaluated (16 angular, 7 linear, and 2 ratio), were compared using ANOVA. Results: For both the CUCLP and CBCLP samples, the most significant differences were observed in the sagittal maxillary prominence. The center that performed primary alveolar bone grafting consistently showed the lowest maxillary prominence. Conclusions: Significant differences in craniofacial morphology, specifically maxillary prominence, exist among patients with CUCLP and CBCLP treated at different North American centers.