Does speech improve after delayed palatal closure in Filipino adults? Effects of combined palatal repair, buccinator flaps and suspension pharyngeal flap

What is already known on the subject Adults presenting with unrepaired cleft palate are not a rare occurrence in middle-income countries. However, many surgeons are hesitant to operate on these individuals because of challenges in repairing the wide adult cleft palate as well as concerns regarding any improvement in speech in older patients. What this paper adds to the existing knowledge This study investigated the effect of delayed palatal closure on speech and self-reported satisfaction in Filipino adults born with a cleft palate. We described the use of a unique three-step surgical procedure including palatal repair, buccinator flaps and suspension pharyngeal flap. Significant improvements in speech understandability and speech acceptability were observed after delayed palatal closure using this three-step surgical sequence. The presence of hypernasality and nasal emission significantly decreased post-surgery and improved velopharyngeal functioning was observed. What are the potential or clinical implications of this work? It is worthwhile to operate on adults with unrepaired palatal clefts considering the positive speech outcomes in terms of speech understandability, speech acceptability, hypernasality, nasal emission, velopharyngeal functioning and self-reported satisfaction. Post-operative speech therapy to improve articulation remains necessary.