| 1. |
- Cornefjord, Måns, et al.
(författare)
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A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 58, s. 132-141
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Forskningsöversikt (refereegranskat)abstract
- The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon's preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.
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| 2. |
- Klintö, Kristina, et al.
(författare)
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Inter-centre comparison of data on surgery and speech outcomes at 5 years of age based on the Swedish quality registry for patients born with cleft palate with or without cleft lip
- 2022
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the Swedish cleft lip and palate registry (CLP registry) is to promote quality control, research and improvement of treatment, by the comparison of long-term results. The aim was to compare data from the CLP registry among the six treatment centres, regarding data on surgery and speech outcomes at 5 years of age.METHODS: The participants were 430 children born in Sweden from 2009 to 2014, with cleft palate with or without cleft lip and without known syndromes and/or additional malformations. The number of primary and secondary palatal surgeries up to 5 years of age, timing of the last primary palatal surgery, percentage consonants correct, percentage non-oral speech errors and perceived velopharyngeal competence at 5 years were assessed. Multivariable binary logistic regression adjusted for sex and cleft type was used to compare results between the six centres.RESULTS: At one centre (centre 4), the palate was closed in one to three stages, and at the remaining centres in one or two stages. At centre 4, more children underwent a higher number of palatal surgeries, and the last primary palatal surgery was performed at a higher age. Children in centre 4 were also less likely to achieve ≥86% correct consonants (OR = 0.169, P = < 0.001), have no non-oral speech errors (OR = 0.347, P = < 0.001), or have competent or marginally incompetent velopharyngeal competence (OR = 0.244, P = < 0.001), compared to the average results of the other centres. No clear association between patient volume and speech outcome was observed.CONCLUSIONS: The results indicated the risk of a negative speech result if the last primary palatal surgery was performed after 25 months of age. Whether the cleft in the palate was closed in one or two stages did not affect speech outcome. The Swedish CLP registry can be used for open comparisons of treatment results to provide the basis for improvements of treatment methods. If deviating negative results are seen consistently at one centre, this information should be acted upon by further investigation and analysis, making changes to the treatment protocol as needed.
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| 3. |
- Klintö, Kristina, et al.
(författare)
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Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months.
- 2014
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Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 49:2, s. 240-254
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Tidskriftsartikel (refereegranskat)abstract
- Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted.
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| 4. |
- Klintö, Kristina, et al.
(författare)
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The impact of speech material on speech judgement in children with and without cleft palate.
- 2011
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Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1460-6984 .- 1368-2822. ; 46:3, s. 348-360
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The chosen method of speech assessment, including type of speech material, may affect speech judgement in children with cleft palate.AIM: To assess the effect of different speech materials on speech judgement in 5-year-old children born with or without cleft palate, as well as the reliability of materials by means of intra- and inter-transcriber agreement of consonant transcriptions.METHODS & PROCEDURES: Altogether 40 children were studied, 20 born with cleft palate, 20 without. The children were audio recorded at 5 years of age. Speech materials used were: single-word naming, sentence repetition (both developed for cleft palate speech assessment), retelling of a narrative and conversational speech. The samples were phonetically transcribed and inter- and intra-transcriber agreement was calculated. Percentage correct consonants (PCC), percentage correct places (PCP), percentage correct manners (PCM), and percentage active cleft speech characteristics (CSC) were assessed. In addition, an analysis of phonological simplification processes (PSP) was performed.OUTCOME & RESULTS: The PCC and CSC results were significantly more accurate in word naming than in all other speech materials in the children with cleft palate, who also achieved more accurate PCP results in word naming than in sentence repetition and conversational speech. Regarding PCM and PSP, performance was significantly more accurate in word naming than in conversational speech. Children without cleft palate did better, irrespective of the speech material. The medians of intra- and inter-transcriber agreement were good in both groups and all speech materials. The closest agreement in the cleft palate group was seen in word naming and the weakest in the retelling task.CONCLUSION & IMPLICATIONS: The results indicate that word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate. If the purpose is to assess connected speech, sentence repetition is a reliable and also valid speech material, with good transcriber agreement and equally good articulation accuracy as in retelling and conversational speech. For typically developing children without a cleft palate, the chosen speech material appears not to affect speech judgement.
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| 5. |
- Klintö, Kristina, et al.
(författare)
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Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate.
- 2015
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Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 50:1, s. 119-128
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Tidskriftsartikel (refereegranskat)abstract
- Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored.
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| 6. |
- Andersson, Ketty, et al.
(författare)
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Does the narrative ability during retelling differ in 5-year-olds born with and without unilateral cleft lip and palate?
- 2022
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Ingår i: Logopedics Phoniatrics Vocology. - : Informa UK Limited. - 1401-5439 .- 1651-2022. ; 47:1, s. 18-24
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Tidskriftsartikel (refereegranskat)abstract
- Background: A previous study has indicated poorer narrative ability during retelling in 5-year-olds with unilateral cleft lip and palate (UCLP) as a group, compared to peers without UCLP. Aim: To investigate if there are any differences between 5-year-olds with and without UCLP in narrative ability during retelling. Methods: A total of 83 children participated, 51 with UCLP and 32 without. They had no known additional malformations or syndromes. The children were audio recorded while performing the Bus Story Test (BST). The recordings were orthographically transcribed. From the transcriptions the BST information score was calculated. The macrostructure of the narratives was assessed with the Narrative Scoring Scheme (NSS), and the microstructure with mean length of utterance in words, grammaticality, grammatical complexity and lexical diversity. Results for children with and without UCLP were compared. Results: The group with UCLP performed better than the group without UCLP in the NSS sub-category Conclusion. No other significant differences were seen between the groups. The UCLP group had a larger standard deviation for the information score than the group without UCLP. Conclusions: The group with UCLP displayed at least as good results as the group without UCLP, but the information score was more varied for the UCLP group than for the group without UCLP.
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| 7. |
- Aspelin, Ellen, et al.
(författare)
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Additional diagnoses in children with cleft lip and palate up to five years of age
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 57:1-6, s. 476-482
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Tidskriftsartikel (refereegranskat)abstract
- Cleft lip and palate (CL/P) is the most common congenital craniofacial malformation and is often associated with additional diagnoses. The purpose of this study was to explore the cumulative five-year incidence of additional diagnoses for patients with cleft lip and palate. Further aims were, type of cleft and type of additional diagnose and to validate CLP registry data on additional diagnoses. Data from the CLP registry regarding children with CL/P in the Southern Health Care Region were retrieved and based on the registry, participants were selected. A review of medical records of participants born 2006–2016 was performed and data regarding participant characteristics and additional diagnoses were collected. Of the 250 participants included in the review of medical records, 90 participants (36%) had an additional diagnosis. Of the total number of identified additional diagnoses (n = 137), cardiovascular system (20.4%) and extremities and skeletal system (17.5%) were the most prevalent categories. The comparison between medical records and the CLP registry of all children showed a 14.4 percentage points higher incidence of additional diagnoses in the medical records. Roughly every third child received an additional diagnosis and diagnoses related to the cardiovascular system were the most frequent. This study also shows that additional diagnoses were under-reported in the CLP registry. Future research is necessary to strengthen associations of additional diagnoses to CL/P.
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| 8. |
- Brunnegård, Karin, et al.
(författare)
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Reliability of Speech Variables and Speech-Related Quality Indicators in the Swedish Cleft Lip and Palate Registry
- 2020
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Ingår i: Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 57:6, s. 715-722
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the reliability of speech variables and speech-related quality indicators in the Swedish quality registry for cleft lip and palate (CLP). Design: Retrospective study. Setting: Primary care university hospitals. Participants: Fifty-two 5-year-old children with unilateral CLP and 41 with bilateral CLP. Main Outcome Measures: Registry data for “percent nonoral errors” and “perceived velopharyngeal competence” (VPC) were compared to reassessments by 4 independent judges based on audio recordings. Interjudge agreement for “percent consonants correct” (PCC) and the reliability of 3 quality indicators were also assessed. Agreement was calculated with single measures intraclass correlation coefficient (ICC) for articulation outcomes, quadratic weighted κ and ICC for VPC, and percentage agreement and κ for quality indicators. Results: When the agreement between registry data and the judges’ reassessments was assessed, the ICC was 0.79 for percent nonoral errors. For VPC, the κ coefficient was 0.66 to 0.75 and the ICC was 0.73. Interjudge agreement for PCC calculated with ICC was 0.85. For the quality indicator “proportion of children with ≥86% correct consonants,” all 4 judges were in agreement for 72% of the cases. For “proportion of children without nonoral speech errors” and “proportion of children with competent or marginally incompetent velopharyngeal function,” the agreement between registry data and the 4 judges was 89% and 85%, respectively. Conclusions: The results indicate that registry data on PCC, percent nonoral errors, VPC, and the quality indicators “proportion of children without nonoral speech errors” and “proportion of children with competent or marginally incompetent velopharyngeal function” are reliable. © 2020, American Cleft Palate-Craniofacial Association.
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| 9. |
- Havstam, Christina, 1963, et al.
(författare)
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Speech in 7- and 10-year-olds born with a unilateral cleft lip and palate: a continued prospective Swedish intercentre study.
- 2023
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Ingår i: Journal of plastic surgery and hand surgery. - : Medical Journals Sweden AB. - 2000-6764 .- 2000-656X. ; 58, s. 149-154
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to report longitudinal speech results in consecutively selected children from each of the six cleft centres in Sweden and to compare the results between centres. The children were born with a non-syndromic unilateral cleft lip and palate, and results from the same cohort at 5 years of age have previously been reported. Background data on medical care in terms of surgery, speech therapy, and hearing between 5 and 10 years of age were collected. Speech recordings of 56 children at 7 years and 54 at 10 years of age were blindly and independently assessed by four speech-language pathologists experienced in cleft palate speech. This resulted in measures of percent consonant correct (PCC) and perceived velopharyngeal competence rated on a three-tier scale. No statistically significant differences were found between centres. PCC scores at 7 years of age ranged from 44-100% (median 97.5) and at 10 years of age from 86-100% (median 100). Competent or marginally incompetent velopharyngeal function was found in 95% of the 7-year-olds and 98% of the 10-year-olds. Speech results were slightly better than previous reports of speech in children born with a unilateral cleft lip and palate.
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| 10. |
- Klintö, Kristina, et al.
(författare)
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Comment on Ombashi, van der Goes, Versnel, Khonsari, van der Molen: guidance to develop a multidisciplinary, international, pediatric registry: a systematic review, Orphanet Journal of Rare diseases, 2023
- 2024
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Ingår i: Orphanet Journal of Rare Diseases. - 1750-1172. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Recently, Ombashi et al. published a systematic review aiming to identify the pitfalls in the development and implementation as well as factors influencing long-term success of a multidisciplinary, international registry for cleft care on a global scale. The purpose of this letter to the editor is to highlight that the review failed to include the Swedish quality registry for patients born with cleft lip and palate, which fulfils the inclusion criteria. The Swedish cleft lip and palate registry is multidisciplinary, has a high coverage and reporting degree, and most outcome measures have been checked for reliability and validity. It is regularly used for open comparisons between treatment centers. Several research studies have been published based on the Swedish cleft lip and palate registry, and more are ongoing. The information we provide about the Swedish cleft lip and palate registry complements and expands the information of the results reported by Ombashi et al. in their research.
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