Samenvatting

Cleft lip and/or palate (CL/P) is a congenital craniofacial defect that arises on average in 1.7 per 1000 live births. This anomaly causes atypical facial appearance, hearing problems, malocclusions and speech disorders. Outcomes in terms of speech are influenced by timing of surgical cleft closure. In the Comprehensive Rehabilitation Services in Uganda (CoRSU) hospital, closure of the entire cleft during a single surgery prior to the age of 6 months is preferred in view of reducing default rates for second surgery and decreasing risks for malnutrition and death. However, some patients arrive the first time at the hospital in later childhood, youth or adulthood. No information about satisfaction and speech outcome was yet available for these Ugandan patients. Moreover, only few, if any studies systematically assessed satisfaction and speech following similar surgical timing protocols. Therefore, in view of searching for the optimal surgical treatment for patients with CL/P, the general aim of the current doctoral thesis was to verify satisfaction and speech in Ugandan patients with CL/P repaired in CoRSU by one experienced surgeon using the Sommerlad technique for palatal closure. In view of clinics and further research, normative nasalance values were first obtained in Ugandan English-speaking males and females (age: 2;7 to 13;5 years) without craniofacial anomalies. No significant age and gender differences were observed. Second, parental satisfaction was studied in Ugandan children with unilateral or bilateral cleft lip and palate (CLP) following synchronous lip and palatal closure. Overall high levels of satisfaction were noted for appearance of lip, nose and face, despite lower satisfaction levels for teeth appearance and speech. Comparison with an age- and gender-matched non-cleft control group revealed significant higher parental dissatisfaction for speech and appearance of teeth and nose in Ugandan patients with CLP. Third, articulation and resonance characteristics of Ugandan patients with early synchronous closure of C(L)P (≤ 6 months) were assessed. Comparison with an age- and gender-matched non-cleft control group revealed various deviations from normal speech development. The Ugandan CP group showed significantly smaller consonant inventories as well as significantly more phonetic disorders, phonological processes and nasal emission/turbulence compared to the control group. In addition, Ugandan patients with C(L)P were compared to a Belgian CP group (matched for cleft type, age and gender) who underwent palatal repair after the age of 6 months. A Ugandan and Belgian age- and gender-matched non-cleft control group was included to control for language, culture and other environmental factors. Comparison of the Ugandan and Belgian CP group revealed at least similar articulation and resonance characteristics. No significant group differences were obtained for perceptual evaluation of resonance, mean nasalance values of oral speech samples, consonant inventories and most phonetic errors and phonological processes. However, the Belgian CP group showed significantly more distortions due to higher occurrence frequencies for (inter)dental articulation of apico-alveolar consonants. Finally, articulation and resonance characteristics as well as patients’ satisfaction with speech were verified in Ugandan patients following delayed one-stage soft and hard palatal closure (≥ 8 years). Comparison with an age- and gender-matched non-cleft control group revealed overall low satisfaction with speech and severely disordered articulation and resonance. The patient group showed significantly smaller consonant inventories, more phonetic and phonological disorders, more hypernasality and nasal emission/turbulence as well as higher mean nasalance values for oral and oronasal speech samples compared to the control group. When findings of the current doctoral thesis are placed within a broader framework, early closure of the entire cleft during a single surgery seems to be an appropriate surgical timing protocol for resource-poor countries. However, prior to application in northern countries, more information on maxillofacial growth disturbances is required. Furthermore, when youngsters and adults present with untreated clefts, delayed cleft repair might be of value, although speech outcomes are poor.