LAUSR

BACKGROUND Although some cleft palates show asymmetric palatal shelf length and/or width intraoperatively, the relationship between palate asymmetry and speech outcomes has not been fully investigated. METHODS This study retrospectively reviewed 234 patients who underwent double opposing Z-plasty (DOZ) for isolated cleft palate (Veau class I-II). Speech outcomes were analyzed to evaluate the association with width and length discrepancy of the palatal shelves using multiple logistic regression adjusting for patient age. RESULTS The mean age at repair were 14.2 ± 5.26 months. The mean palatal shelf width and length differences were 0.87 ± 0.97 mm and 1.63 ± 1.61 mm, respectively. The mean age at initial and follow-up assessment was 37.6 ± 5.70 months (n=234) and 66.2 ± 8.81 months (n=120). Multivariate logistic regression analysis of initial speech outcomes showed odds ratios in width discrepancy of 1.67 (p = 0.0703), 1.59 (p = 0.0104), and 2.01 (p = 0.0051) for nasal emission, hypernasality, and compensatory articulation, respectively. Additional analysis including follow-up outcomes also revealed that width discrepancy of the palatal shelves had higher odds ratios for nasal emission, hypernasality and compensatory articulation (1.49, p=0.0406; 1.36, 0.0660; 1.65, 0.0170, respectively). There was no association between length discrepancy and all speech abnormalities. CONCLUSIONS Greater discrepancies in palatal shelf width, rather than in length, were associated with poorer speech outcomes after DOZ. We suggest that DOZ is effective for longitudinally asymmetric cleft palates.