Palate Repair Timing Under Age 15 Months and Early Speech Outcomes

Importance Early primary palatoplasty is recommended to optimize speech outcomes, but it is unclear whether small variations in timing within the first 15 months affect the development of passive cleft speech characteristics (CSCs), which can persist despite early repair and impact early speech development. Objective To examine whether differences in timing of primary palatoplasty before age 15 months are associated with development of passive CSCs at age 18 to 24 months and at age 36 months. Design, Setting, and Participants This is a longitudinal cohort study including data from the Cleft Collective, a cohort of children with clefting in the UK recruited from all UK regional cleft centers. Recruitment and data collection began in 2013 and is ongoing. Analysis reported in this study took place on August 14, 2024. Participants were children with cleft palate with or without a cleft lip who had palatoplasty before 15 months and completed speech assessments at 18 to 24 months and/or at 36 months. Exposures Palatoplasty before age 15 months. Main Outcomes and Measures Presence of passive CSCs at 18 to 24 months and at 36 months. Results Speech assessment data were available for 157 children at 18 to 24 months (mean [SD] age at primary palatoplasty, 9.6 [2.3] months; 75 male [47.8%]), of whom 53.5% had cleft palate only, and 174 children at 36 months (mean [SD] age at primary palatoplasty, 9.7 [2.2] months; 90 male [51.7%]), of whom 47.7% had cleft palate only. Palatoplasty technique was available for 105 children at 18 to 24 months and 117 children at 36 months; 94% received an intravelar veloplasty across both samples. Passive CSCs occurred in 18.5% of children aged 18 to 24 months and 16.7% of children aged 36 months. No association was seen at 18 to 24 months; at 36 months, each additional month at repair was associated with increased odds of passive CSCs (odds ratio, 1.24; 95% CI, 1.00-1.54). Conclusions and Relevance Results of this study suggest that even before age 15 months, later palatoplasty may be associated with modest increases in the likelihood of passive CSCs at age 36 months, highlighting the potential role of small delays in early speech and velopharyngeal function.