Speech Status of Post-Adolescents Following Bone Flap Palatal Surgery

Abstract

The purpose of this paper is to further clarify the bone flap method used in cleft palate surgery and to describe the speeech of post—adolescents who received this method of surgery as infants. It is our feeling that complete surgical closure of the palate should be obtained before the child learns to speak. Such early closure often prevents the acquisition of poor speech habits during the early formative period. This method of surgery is used as early as the ninth month with infants who have otherwise developed normally. It has beeen shown in previous studies of the bone flap technique that intermolar width between the first permanent molars was within normal limits as determined by its occlusal relationship with the lower molars. The anterior narrowing of the palate is often seecondary to the action of the labial musculature. Many patients who have never had palatal sur— gery or who have had palatal surgery by other techniques, may show the same type of anterior palate narrowing. Operative Technique The operative technique itself begins with incisions made inside the alveolar border in an anterior-posterior direction starting behind the tu— berosity of the superior maxilla on each side and extending forward approximately 3/4 the length of the hard palate. The line of incision is kept just inside the alveolar ridge. Chisels are then introduced, usually in series. A first chisel (below) divides the hamulus process in the perpendicular with a fracture of the medial segment. The chisels anterior to this actually fracture the palatal process medialward and bring it into contact with the opposite process. In order to avoid injury to the teeth, unerupted or otherwise, leverage pressure should not be applied upon the alveolar