Long-Term Speech Outcomes in Unilateral Cleft Lip and Palate: A Comparative Study of Early and Delayed Hard Palate Closure

Background: Evidence on the comparative effectiveness of surgical protocols for cleft lip and palate remains limited, especially regarding long-term speech outcomes. Therefore, this study evaluates speech outcomes at 5, 12, and 22 years in patients with unilateral cleft lip and palate (UCLP) to guide protocol selection. Methods: This prospective cross-sectional study included 285 UCLP patients treated at 2 Dutch academic hospitals. Patients were assessed at 1 of 3 predefined ages (5, 12, or 22 y) during routine follow-up; only a minority were assessed at more than one time point. Four protocols with different timing for hard palate closure were compared: Late Delayed Hard Palate Closure Protocol (L-DHPCP), Early Delayed Hard Palate Closure Protocol (E-DHPCP), One-Stage Palatoplasty Protocol (OSPP), and Oslo Protocol (OP). Speech outcomes were assessed using the ICHOM standard set for cleft lip and palate, including clinical (Percent Consonant Correct, Velopharyngeal Competence) and patient-reported (Intelligibility in Context Scale, CLEFT questionnaire) outcome measures and compared using ordinal logistic regression. Results: At 5 years, OSPP showed the most favourable speech results, significantly outperforming L-DHPCP and E-DHPCP. At 12 years, OP exhibited the most favourable results, while differences between protocols diminished. By 22 years, no significant differences were observed between the available protocols (E-DHPCP and L-DHPCP), though speech errors persisted in some patients. Conclusion: Early hard palate closure protocols, particularly OSPP and OP, were associated with better short-term and intermediate speech outcomes compared with DHPCPs. While differences diminished by 22 years, early closure should be prioritised in nonsyndromic UCLP patients to prevent persistent speech errors and minimise the burden of speech-enhancing surgery and speech therapy.