Phonological Patterns in Standard-Timed Versus Late-Repaired Unilateral Cleft Lip and Palate: A Comparative Case Analysis

Phonological processes are systematic speech simplifications that typically disappear by age 4 to 6 years. In children with repaired cleft lip and palate (RCLP), suppression of these processes is often delayed; however, evidence from Tamil-speaking children remains limited. Two 7-year-old Tamil-speaking boys, each with unilateral cleft lip and palate (UCLP), were compared; they differed only in the timing of primary palate repair. Child A underwent repair at 18 months (standard repair time), Child B underwent repair at 6 years (late repair). Speech samples were elicited using a standardized picture-naming task using the Consonant and Phonological Process Analysis tool for Tamil (43 items). Phonetic transcription and process analysis were performed independently. Child A (standard time repair) demonstrated 7 distinct phonological processes, whereas Child B (late repair) demonstrated 12 processes at higher frequency, including non-developmental patterns such as initial and final consonant deletion, depalatalization, deaffrication, and consonant assimilation. A language-specific process, retroflex fronting was identified in both children. Delayed palatal repair is associated with a greater number and persistence of developmental and non-developmental phonological processes, reflecting structural constraints and phonological mislearning. Early surgical repair and timely speech-language intervention are critical for optimal phonological outcomes in children with RCLP.