Beyond Prevalence: Understanding the Relationship Between Early Anatomic Factors and the Likelihood for Cleft Speech Characteristics

Purpose: This study investigates early anatomic determinants influencing the likelihood of cleft speech characteristics (CSCs) in children with cleft palate with or without lip involvement (CP+/−L). The primary objective was to identify critical anatomic factors within the first year of life that impact the presence of CSCs at Age 3. Methods: The Cleft Collective Longitudinal Cohort Study of children born with a CP+/−L was utilized. Data from 293 children were included in the analyses. Anatomic variables, including cleft type, pre-operative cleft width and fistula status, were assessed in relation to CSCs. Logistic regression analyses were adjusted for confounding variables such as age, sex and hearing status. Results: At 36 months, 64.9% of children with cleft palate exhibited CSCs. Anterior CSCs were most common (36.2%), while passive CSCs were least common (16.0%). Cleft type strongly influenced CSC prevalence, with UCLP and BCLP associated with higher odds of any CSC. Wider clefts were associated with passive, non-oral and posterior CSCs. Fistula presence markedly increased the odds of CSCs, especially passive and posterior CSCs. Logistic regression analyses revealed strong associations between cleft type, cleft width, fistula and specific CSCs outcomes. Conclusions: The multifactorial nature of CSC production in children with CP+/−L is underscored by distinct impacts of cleft type, pre-operative cleft width and fistula status. Early, individualized interventions are paramount, emphasizing the need for proactive measures, including effective fistula management and speech therapy. Prioritizing prevention strategies for children with anatomic risk factors may reduce the likelihood of producing CSCs, contributing to more typical speech development and optimizing long-term speech outcomes for affected children. WHAT THIS PAPER ADDS: What is already known on this subject Children with cleft palate, with or without lip involvement (CP+/−L), frequently develop speech sound disorders due to anatomic variations affecting the craniofacial complex. Previous research has identified a range of speech difficulties in these children, with variability in the prevalence and types of cleft speech characteristics (CSCs). Less is known about the precise multifactorial impact of specific anatomic factors and their influence on the likelihood of developing CSCs, necessitating further investigation. What this paper adds to existing knowledge This study identifies the multifactorial impact of early anatomic factors, including cleft type, cleft width and fistula status, on the likelihood of cleft speech characteristics (CSCs) at Age 3 in children with CP+/−L. This research enhances understanding of how these anatomical factors influence CSCs, offering valuable data to guide future studies and/or clinical practices aimed at optimizing speech development in children with cleft conditions. What are the potential or actual clinical implications of this work? The findings emphasize the importance of early and individualized speech assessments and interventions for children with cleft conditions, particularly those with wider clefts and fistulas. Early detection and timely surgical and therapeutic interventions could reduce the likelihood of CSCs, improving long-term speech outcomes and enabling more effective management plans tailored to the specific anatomic profiles for these children.