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The focus of this book is on speech production and speech processing associated with cleft palate, covering phonetic (perceptual and instrumental), phonological and psycholinguistic perspectives, and including coverage of implications for literacy and education, as well as cross-linguistic differences. It draws together a group of international experts in the fields of cleft lip and palate and speech science to provide an up-to-date and in-depth account of the nature of speech production, and the processes and current evidence base of assessment and intervention for speech associated with cleft palate. The consequences of speech disorders associated with cleft on intelligibility and communicative participation are also covered. This book will provide a solid theoretical foundation and a valuable clinical resource for students of speech-language pathology, for practising speech-language pathologists, and for others interested in speech production in cleft palate, including researchers and members of multi-disciplinary cleft teams who wish to know more about the nature of speech difficulties associated with a cleft palate.

The purpose of this pilot study was to investigate the extent to which a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT+ PE), improved the language and speech outcomes of toddlers with cleft lip and/or palate (CL/P). Nineteen children between 15 and 36 months (M = 25 months) with nonsyndromic CL/P and typical cognitive development were randomly assigned to a treatment (EMT+PE) or nontreatment, business-as-usual (BAU), experimental condition. Participants in the treatment group received forty-eight 30-min sessions, biweekly during a 6-month period. Treatment was delivered in a university clinic by trained speech language pathologists; fidelity of treatment was high across participants. Children in the treatment group had significantly better receptive language scores and a larger percentage of consonants correct than children in the BAU group at the end of intervention. Children in the treatment group made greater gains than children in the BAU group on most language measures; however, only receptive language, expressive vocabulary (per parent report), and consonants correct were significant. The results of this preliminary study indicate that EMT+PE is a promising early intervention for young children with CL/P. Replication with a larger sample and long-term follow-up measures are needed.

The anatomical deformation in cleft patients requires speech therapy to support cleft patients as best as possible. The aim of this study was to evaluate the standard of knowledge of therapists concerning clefts. Furthermore, the study aimed to determine whether there was a difference between therapists with and without treatment experience in cleft patients as well as among therapists with more or less years of general professional experience. We developed a questionnaire about different areas of speech therapy: “General,” “Speech therapy,” “Development opportunities and influences,” and “Interdisciplinary collaboration.” For a total of 50 questions, we used single-, multiple-choice questions and the visual analog scale (VAS). Speech therapists with experience in treating cleft patients (n = 43) felt more confident regarding their knowledge and abilities than therapists without experience (n = 61), especially concerning nonspecialist disciplines and cleft specifications. No difference was found in therapy duration, indications, influences, and potential for development. Professional experience (years) and cleft experience correlate; with more knowledge in the group with more than 8 years of experience. Cleft centers remain first choice for patients’ care thanks to the higher number of patients, daily treatment routine, the direct contact among examiners, and a common treatment concept.

Background Cleft lip and palate are common congenital anomalies that impose significant healthcare and economic burdens. The COVID-19 pandemic disrupted conventional speech-language therapy, necessitating the use of telepractice interventions. The Application for Articulation Therapy-Thai (AAT-T) was developed to address these limitations. This study aimed to estimate the economic costs and resource use associated with delivering AAT-T during the pandemic. Methods A descriptive micro-costing analysis was conducted using retrospective data from a clinical efficacy trial of AAT-T performed between May and October 2022 at Srinagarind Hospital, Thailand. Costs were estimated from a societal perspective and included direct medical costs, direct non-medical costs, and indirect costs related to caregiver productivity loss and informal care. Costs were reported in Thai baht (THB) at 2022 prices. A generalized linear model with a gamma distribution and log-link function was used to examine factors associated with variations in total costs. Results Eighteen children with CP ± L were included in the analysis. The mean total societal cost per child was THB 28,928.36 (95% CI: 24,442.87–33,413.85). Direct non-medical costs accounted for the largest proportion of total costs (45.28%), primarily driven by transportation expenses. Direct medical costs represented 31.99% of total costs, while indirect costs related to caregiver productivity loss and informal care accounted for 22.73%. Regression analysis showed that child age was significantly associated with higher total costs, with each additional year of age associated with an approximately 10% increase in expected costs (cost ratio: 1.10; 95% CI: 1.02–1.18; p  = 0.02). Conclusion Telepractice-based speech-language therapy using AAT-T appears to be a feasible service delivery approach during public health emergencies and may help address geographic and caregiver-related barriers to care for children with CP ± L in Thailand. Nevertheless, direct non-medical and indirect costs remain substantial, underscoring the importance of accounting for family and caregiver burden in health service planning. Further research is required to evaluate the clinical effectiveness, efficiency, and scalability of AAT-T in post-emergency settings before consideration of broader integration into routine speech-language therapy services.

Objectives Mobile applications are becoming essential for speech therapy, especially in areas with limited access to professional speech therapists. This technological intervention is especially pertinent during pandemics, which further restrict access to traditional therapeutic modalities. The objective of this study was to develop and evaluate a mobile application for articulation therapy, specifically designed for pediatric patients with articulation disorders associated with cleft palate. Material and Methods The articulation exercises incorporated in the application encompassed 27 Thai initial and final consonant sounds, presented through video demonstrations and tabular reading materials. These materials included nonsense syllables, words, phrases, and sentences. The content validity was assessed using the Item‐Objective Congruence (IOC) index. Face validity and functional satisfaction were evaluated by a panel comprising four speech‐language pathologists (SLPs), five children with cleft palate with or without cleft lip (CP ± L) and their respective caregivers, and an expert in application design. The clinical efficacy of the application for speech correction was subsequently assessed in a cohort of 19 children diagnosed with CP ± L. Results The Application for Articulation Therapy‐Thai (AAT‐T) was finalized after four iterative revisions. The IOC index for the application ranged from 0.80 to 1.00, indicating strong content validity. Functional satisfaction scores ranged from 76% to 100%, suggesting high user acceptability. Nineteen children participated in the clinical efficacy assessment; however, one child was withdrawn due to the inability to complete 6‐month follow‐up. The results demonstrated that AAT‐T significantly reduced articulation errors in connected speech (mean difference = 2.33, SD = 2.40, 95% CI = 1.14–3.53, p < 0.001). Conclusions The AAT‐T application emerged as an accessible, engaging, and motivational tool for articulation practice. Its efficacy in speech correction was demonstrated.

Cleft lip and palate (CLP) significantly impact speech and language development in children. In remote areas, access to specialised services is often limited, necessitating innovative approaches for effective service delivery. This case report explores the potential of tele-supervised intervention provided by community-based rehabilitation workers (CBRWs) to enhance communication outcomes for children with CLP. A comprehensive therapy programme was developed, targeting the child’s speech needs and led by a CBRW under remote supervision from speech-language pathologists (SLPs). The SLPs provided real-time guidance to the CBRWs in stimulus selection, trial administration, response monitoring and reinforcement strategies. The tele-supervised intervention led to significant improvement in the child’s communication outcomes by encouraging active participation and correct exercise execution. This approach also enhanced service delivery in remote areas by improving access to specialised services, building the capacity of local healthcare providers and facilitating ongoing professional development.

Femoral-facial syndrome (FFS) is a rare disorder characterised by hypoplasia of the femur and unusual facies. We report a case with multiple skeletal malformations in the lumbosacral spine and pelvis, and an anteriorly placed ectopic right kidney in a case of FFS diagnosed clinically and radiographically in a toddler. We also highlight the challenges faced during nutritional rehabilitation prior to cleft palate surgery because of the lack of syndrome-specific growth charts.

Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone.

Objectives This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary suturai loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients. Materials and Methods Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison. Results The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2–T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ┴ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, −1.58 to 2.83), Occl P-SN (°) (-3.98, −5.99 to −1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, −0.05 to 8.15), and IMPA (°) (-5.77, −9.74 to −1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group. Conclusions Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).

A 49-year-old male patient with residual cleft palate and missing pre-maxilla presented with an ill-fitting and unaesthetic maxillary denture. The posterior teeth were periodontally sound but crowded and had defective restorations and secondary caries. We restored the bilateral maxillary canines and first premolars with conical telescopic crowns having magnetic keepers. A metal-reinforced acrylic overdenture with magnetic attachments corresponding to the keepers of the telescopic crowns was fabricated. The telescopic crowns provided a single path of insertion, retention and stability to the prosthesis. The magnetic attachments provided additional retention and self-centring properties. The prosthesis effectively sealed the oronasal communication and enhanced the function, aesthetics and oral hygiene. The 6-month and 1-year follow-ups revealed that the patient was delighted, and the prosthesis provided excellent obturation and function. Periodic follow-up, maintenance, patient education and meticulous oral hygiene are vital for long-term success of such prostheses.