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This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.Key pointsAn overview of the impact of cleft lip and palate on speech.Speech is a core life skill: palatal, dental, and occlusal anomalies associated with cleft can affect speech clarity at any age.Speech prosthetics is an appropriate treatment option for velopharyngeal dysfunction in selected patients and should be delivered by a specialist multidisciplinary team.

This is a practical and accessible handbook of evidence-based practice for the assessment and management of speech disorders relating to cleft palate and VPD. The book specifi cally draws on UK expert knowledge and practice with reference to research and current clinical procedure, and the accompanying download provides many useful resources such as assessment frameworks and checklists, phonetics resources, treatment plans and decision-making aids.

Objective To develop national standards for speech outcomes and processes of care for children with cleft palate ± lip and to test the standards using national data. Design, Setting, and Participants In this large, multicenter, prospective cohort study, speech recordings of 1110 five-year-olds with cleft palate involvement (born 2001 to 2003) were collected by 12 cleft centers in Great Britain and Ireland. Recordings were analyzed by consensus by specialist speech and language therapists using the Cleft Audit Protocol for Speech-Augmented. Results were benchmarked against evidence-based process and speech outcome standards and statistical analysis undertaken. Results From the 1110 children audited, 48% (530) had speech within the normal range. This was not significantly different from the agreed standard of 50% (P = .20, CI = 45–50%). Sixty-six percent (734) had speech with no evidence of structurally related speech problems or history of speech-related secondary surgery. This was significantly below the standard of 70% (P =.007, CI = 62–69%). Sixty percent (666) had no serious cleft-related articulation errors. This was significantly better than the agreed standard of 50% (P < .001, CI = 67–73%). More than 80% of 2-year-olds received a specialist speech and language assessment against a benchmark of 100%. Conclusions Developing standards has facilitated more meaningful reporting of speech outcomes and treatment processes. Evidence-based standards were defined and extensively tested, enabling centers to compare their performance with national trends. One 5-year outcome standard was achievable; the other two standards will require modification through the mandatory annual national audit program.

Nasal speech associated with velopharyngeal dysfunction (VPD) is seen in children and adults with cleft palate and other conditions that affect soft palate function, with negative effects on quality of life. Treatment options include surgery and prosthetics depending on the nature of the problem. Speech therapy is rarely offered as an alternative treatment as evidence from previous studies is weak. However there is evidence that visual biofeedback approaches are beneficial in other speech disorders and that this approach could benefit individuals with nasal speech who demonstrate potential for improved speech. Theories of learning and feedback also lend support to the view that a combined feedback approach would be most suitable. This feasibility study therefore aimed to develop and evaluate Visual Feedback Therapy (VFTh), a new behavioural speech therapy intervention, incorporating speech activities supported by visual biofeedback and performance feedback, for individuals with mild to moderate nasal speech. Evaluation included perceptual, instrumental and quality of life measures. Eighteen individuals with nasal speech were recruited from a regional cleft palate centre and twelve completed the study, six female and six male, eleven children (7 to 13 years) and one adult, (43 years). Six participants had repaired cleft palate and six had VPD but no cleft. Participants received 8 sessions of VFTh from one therapist. The findings suggest that that the intervention is feasible but some changes are required, including participant screening for adverse response and minimising disruptions to intervention scheduling. In blinded evaluation there was considerable variation in individual results but positive changes occurred in at least one speech symptom between pre and post-intervention assessment for eight participants. Seven participants also showed improved nasalance scores and seven had improved quality of life scores. This small study has provided important information about the feasibility of delivering and evaluating VFTh. It suggests that VFTh shows promise as an alternative treatment option for nasal speech but that further preliminary development and evaluation is required before larger scale research is indicated.