{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:14:34Z","timestamp":1791994474808,"version":"4.4.0"},"reference-count":107,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: This systematic review investigates how different surgical techniques influence speech outcomes in children with cleft palate, focusing on the effectiveness of key palatoplasty methods and the timing of surgery on vocal function. Methods: A thorough search of the PubMed, Scopus, and Web of Science databases was conducted for studies published between 2014 and 2024, including clinical research reporting speech results after palatal repair, with bias assessed using the ROBINS tool. Additionally, two clinical cases are presented to demonstrate the practical application of the surgical approaches. Results: Analysis of fourteen studies revealed that modified Z-plasty and V-Y procedures enhance soft palate mobility and reduce hypernasality, although they require advanced surgical skills. Early closure of the hard palate, performed within the first year of life, was linked to improved consonant articulation compared to later surgeries. No significant differences were found between single-stage and two-stage repairs, but surgeon experience emerged as a crucial factor influencing outcomes. Conclusions: Overall, both the surgical technique selected and the timing of intervention play important roles in optimizing speech development in children affected by cleft palate.<\/jats:p>","DOI":"10.3390\/bioengineering12080877","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:44:21Z","timestamp":1755186261000},"page":"877","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Evaluation of Surgical Protocols for Speech Improvement in Children with Cleft Palate: A Systematic Review and Case Series"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0104-6337","authenticated-orcid":false,"given":"Angelo Michele","family":"Inchingolo","sequence":"first","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna","family":"Dipalma","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8136-7444","authenticated-orcid":false,"given":"Paola","family":"Bassi","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalba","family":"Lagioia","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirka","family":"Cavino","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8701-3734","authenticated-orcid":false,"given":"Valeria","family":"Colonna","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"de Ruvo","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3797-5883","authenticated-orcid":false,"given":"Francesco","family":"Inchingolo","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Giudice","sequence":"additional","affiliation":[{"name":"Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, 11, Piazza Giulio Cesare, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Palermo","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6366-1039","authenticated-orcid":false,"given":"Alessio Danilo","family":"Inchingolo","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1097\/SCS.0b013e31820f3691","article-title":"Treatment of Velopharyngeal Insufficiency after Cleft Palate Repair Depending on the Velopharyngeal Closure Pattern","volume":"22","author":"Ghandour","year":"2011","journal-title":"J. Craniofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1016\/j.ijporl.2015.07.044","article-title":"Furlow Palatoplasty for Previously Repaired Cleft Palate with Velopharyngeal Insufficiency","volume":"79","author":"Nassar","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S102","DOI":"10.4103\/0970-0358.57197","article-title":"Cleft Palate Repair and Variations","volume":"42","author":"Agrawal","year":"2009","journal-title":"Indian J. Plast. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/SCS.0000000000008926","article-title":"Speech Symptoms of Velopharyngeal Insufficiency and the Incidence of Secondary Speech Surgery in 10-Year-Old Children with Unilateral Cleft Lip and Palate: Comparison of 2 Randomized Surgical Methods for Primary Palatal Surgery","volume":"34","author":"Alaluusua","year":"2023","journal-title":"J. Craniofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1597\/15-292","article-title":"A Standard Set of Outcome Measures for the Comprehensive Appraisal of Cleft Care","volume":"54","author":"Allori","year":"2017","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Laforgia, A., Inchingolo, A.D., Riccaldo, L., Avantario, P., Buongiorno, S., Malcangi, G., Bordea, I.R., Palermo, A., Inchingolo, F., and Inchingolo, A.M. (2024). The Use of Platelet-Rich Fibrin (PRF) in the Management of Dry Socket: A Systematic Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms251810069"},{"key":"ref_7","first-page":"8645","article-title":"Effect of Probiotics on the Occurrence of Nutrition Absorption Capacities in Healthy Children: A Randomized Double-Blinded Placebo-Controlled Pilot Study","volume":"23","author":"Ballini","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A.D., Guglielmo, M., Morolla, R., Palumbo, I., Riccaldo, L., Mancini, A., Palermo, A., Malcangi, G., and Inchingolo, A.M. (2024). Nanotechnology and Its Application in Dentistry: A Systematic Review of Recent Advances and Innovations. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175268"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A.D., Inchingolo, A.M., Piras, F., Carpentiere, V., Garofoli, G., Azzollini, D., Campanelli, M., Paduanelli, G., and Palermo, A. (2023). Artificial Intelligence and Its Clinical Applications in Orthodontics: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13243677"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A.M., Trilli, I., Ferrante, L., Noia, A.D., de Ruvo, E., Inchingolo, F., Mancini, A., Cocis, S., and Palermo, A. (2025). Management of Oro-Antral Communication: A Systemic Review of Diagnostic and Therapeutic Strategies. Diagnostics, 15.","DOI":"10.3390\/diagnostics15020194"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/PRS.0b013e3181845a21","article-title":"The Importance of Radical Intravelar Veloplasty during Two-Flap Palatoplasty","volume":"122","author":"Andrades","year":"2008","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1177\/1055665620923925","article-title":"Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique","volume":"57","author":"Baillie","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/00006534-198402000-00007","article-title":"Late Results of Primary Veloplasty: The Marburg Project","volume":"73","author":"Bardach","year":"1984","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting Linear Mixed-Effects Models Using Lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J. Stat. Softw."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106198","DOI":"10.1016\/j.jcomdis.2022.106198","article-title":"Better Speech Outcomes after Very Early Palatal Repair?\u2014A Longitudinal Case-Control Study in Ugandan Children with Cleft Palate","volume":"96","author":"Bettens","year":"2022","journal-title":"J. Commun. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1177\/1055665620980249","article-title":"Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients with Cleft Palate","volume":"58","author":"Bettens","year":"2021","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1001\/jamafacial.2017.0639","article-title":"Association of Velopharyngeal Insufficiency with Quality of Life and Patient-Reported Outcomes After Speech Surgery","volume":"19","author":"Bhuskute","year":"2017","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1044\/jslhr.4103.676","article-title":"Acquisition of Linguistic and Cognitive Skills by Children with Cleft Palate","volume":"41","author":"Broen","year":"1998","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Laforgia, A., Inchingolo, A.D., Piras, F., Colonna, V., Giorgio, R.V., Carone, C., Rapone, B., Malcangi, G., Inchingolo, A.M., and Inchingolo, F. (2024). Therapeutic Strategies and Genetic Implications for Periodontal Disease Management: A Systematic Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25137217"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Laforgia, A., Inchingolo, A.M., Inchingolo, F., Sardano, R., Trilli, I., Di Noia, A., Ferrante, L., Palermo, A., Inchingolo, A.D., and Dipalma, G. (2025). Paediatric Dental Trauma: Insights from Epidemiological Studies and Management Recommendations. BMC Oral Health, 25.","DOI":"10.1186\/s12903-024-05222-5"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mancini, A., Chirico, F., Colella, G., Piras, F., Colonna, V., Marotti, P., Carone, C., Inchingolo, A.D., Inchingolo, A.M., and Inchingolo, F. (2025). Evaluating the Success Rates and Effectiveness of Surgical and Orthodontic Interventions for Impacted Canines: A Systematic Review of Surgical and Orthodontic Interventions and a Case Series. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-05635-w"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Muntean, A., Mzoughi, S.M., Pacurar, M., Candrea, S., Inchingolo, A.D., Inchingolo, A.M., Ferrante, L., Dipalma, G., Inchingolo, F., and Palermo, A. (2024). Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries\u2014A Systematic Review. Children, 11.","DOI":"10.3390\/children11040499"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jcms.2006.07.858","article-title":"Influence of Treatment Concept, Velopharyngoplasty, Gender and Age on Hypernasality in Patients with Cleft Lip, Alveolus and Palate","volume":"34","author":"Joos","year":"2006","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1097\/PRS.0b013e3181b03824","article-title":"Current Surgical Practices in Cleft Care: Cleft Palate Repair Techniques and Postoperative Care","volume":"124","author":"Katzel","year":"2009","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1597\/1545-1569_2002_039_0277_tcbnaa_2.0.co_2","article-title":"The Correlation between Nasalance and a Differentiated Perceptual Rating of Speech in Dutch Patients with Velopharyngeal Insufficiency","volume":"39","author":"Keuning","year":"2002","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1159\/000076937","article-title":"Correlation between the Perceptual Rating of Speech in Dutch Patients with Velopharyngeal Insufficiency and Composite Measures Derived from Mean Nasalance Scores","volume":"56","author":"Keuning","year":"2004","journal-title":"Folia Phoniatr. Et Logop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/2000656X.2019.1615929","article-title":"Speech in 5-Year-Olds Born with Unilateral Cleft Lip and Palate: A Prospective Swedish Intercenter Study","volume":"53","author":"Havstam","year":"2019","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/1460-6984.12068","article-title":"Phonology in Swedish-Speaking 3-Year-Olds Born with Cleft Lip and Palate and the Relationship with Consonant Production at 18 Months","volume":"49","author":"Olsson","year":"2014","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1597\/12-299","article-title":"Speech and Phonology in Swedish-Speaking 3-Year-Olds with Unilateral Complete Cleft Lip and Palate Following Different Methods for Primary Palatal Surgery","volume":"51","author":"Svensson","year":"2014","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1177\/1055665619897233","article-title":"Internationally Adopted Children with Unilateral Cleft Lip and Palate-Consonant Proficiency and Perceived Velopharyngeal Competence at the Age of 5","volume":"57","author":"Larsson","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14015439.2022.2083673","article-title":"Persisting Speech Difficulties at 7\u20138 Years of Age\u2013a Longitudinal Study of Speech Production in Internationally Adopted Children with Cleft Lip and Palate","volume":"49","author":"Larsson","year":"2024","journal-title":"Logop. Phoniatr. Vocol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/1460-6984.12307","article-title":"Speech Production in 3-Year-Old Internationally Adopted Children with Unilateral Cleft Lip and Palate","volume":"52","author":"Larsson","year":"2017","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ijom.2016.09.019","article-title":"Cleft Relapse and Oronasal Fistula after Furlow Palatoplasty in Infants with Cleft Palate: Incidence and Risk Factors","volume":"46","author":"Li","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s00784-013-1084-2","article-title":"Vomer Flap for Hard Palate Repair Is Related to Favorable Maxillary Growth in Unilateral Cleft Lip and Palate","volume":"18","author":"Liao","year":"2014","journal-title":"Clin. Oral Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.bjoms.2020.04.026","article-title":"Analysis of Velopharyngeal Function and Speech Outcomes of Sommerlad Palatoplasty Combined with Sphincter Pharyngoplasty in Surgical Repair of Older Patients with Cleft Palate: Experience from a Major Craniofacial Surgery Centre in Eastern China","volume":"58","author":"Liu","year":"2020","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102707","DOI":"10.1016\/j.amsu.2021.102707","article-title":"Need for Velopharyngeal Surgery after Primary Palatoplasty in Cleft Patients. A Retrospective Cohort Study and Review of Literature","volume":"69","author":"Tache","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/1460-6984.12542","article-title":"Randomized Controlled Trial Comparing Parent Led Therapist Supervised Articulation Therapy (PLAT) with Routine Intervention for Children with Speech Disorders Associated with Cleft Palate","volume":"55","author":"Sweeney","year":"2020","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1097\/PRS.0000000000000224","article-title":"Outcomes of Cleft Palatal Repair for Internationally Adopted Children","volume":"133","author":"Sullivan","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1080\/08870446.2016.1143944","article-title":"Psychological Adjustment to Cleft Lip and\/or Palate: A Narrative Review of the Literature","volume":"31","author":"Stock","year":"2016","journal-title":"Psychol. Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/SCS.0000000000004261","article-title":"Reliability of the Dutch Cleft Speech Evaluation Test and Conversion to the Proposed Universal Scale","volume":"29","author":"Spruijt","year":"2018","journal-title":"J. Craniofac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1111\/1460-6984.12633","article-title":"Speech Input Processing in Children Born with Cleft Palate: A Systematic Literature Review with Narrative Synthesis","volume":"56","author":"Southby","year":"2021","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1097\/01.PRS.0000085599.84458.D2","article-title":"A Technique for Cleft Palate Repair","volume":"112","author":"Sommerlad","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1054\/jcms.2001.0217","article-title":"The Eurocleft Project 1996\u20132000: Overview","volume":"29","author":"Shaw","year":"2001","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1597\/1545-1569_2001_038_0030_clapci_2.0.co_2","article-title":"Cleft Lip and Palate Care in the United Kingdom\u2013the Clinical Standards Advisory Group (CSAG) Study. Part 3: Speech Outcomes","volume":"38","author":"Sell","year":"2001","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/2000656X.2016.1263202","article-title":"A Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 1. Planning and Management","volume":"51","author":"Semb","year":"2017","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1080\/02699206.2021.1912187","article-title":"Early Speech and Language Intervention in Brazilian-Portuguese Toddlers with Cleft Lip and\/or Palate","volume":"36","author":"Scherer","year":"2022","journal-title":"Clin. Linguist. Phon."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1097\/01.PRS.0000160269.73323.67","article-title":"Maxillofacial Morphology in Children with Complete Unilateral Cleft Lip and Palate Treated by One-Stage Simultaneous Repair","volume":"115","author":"Savaci","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/SCS.0000000000007515","article-title":"Risk Factors of Fistula Following Primary Palatoplasty","volume":"32","author":"Saothonglang","year":"2021","journal-title":"J. Craniofac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1044\/2021_JSLHR-21-00367","article-title":"On the Benefits of Speech-Language Therapy for Individuals Born with Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data","volume":"65","author":"Sand","year":"2022","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_50","first-page":"293","article-title":"Speech Outcome in Unilateral Complete Cleft Lip and Palate Patients: A Descriptive Study","volume":"15","author":"Rullo","year":"2014","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/0266-4356(95)90040-3","article-title":"The Correlation between Training and Skill of the Surgeon and Reoperation Rate for Persistent Cleft Palate Speech","volume":"33","author":"Rintala","year":"1995","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jcms.2017.03.006","article-title":"Maxillofacial Growth and Speech Outcome after One-Stage or Two-Stage Palatoplasty in Unilateral Cleft Lip and Palate. A Systematic Review","volume":"45","author":"Reddy","year":"2017","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1597\/09-105","article-title":"Early Consonant Production in Swedish Infants with and without Unilateral Cleft Lip and Palate and Two-Stage Palatal Repair","volume":"48","author":"Lohmander","year":"2011","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1159\/000362501","article-title":"Impact of Early Synchronous Lip and Palatal Repair on Speech","volume":"65","author":"Luyten","year":"2013","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ijporl.2014.02.012","article-title":"The Impact of Palatal Repair before and after 6 Months of Age on Speech Characteristics","volume":"78","author":"Luyten","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/PRS.0b013e3182910acb","article-title":"Prospective Analysis of Presurgical Risk Factors for Outcomes in Primary Palatoplasty","volume":"132","author":"Mahoney","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ijporl.2018.12.035","article-title":"The Incidence of Velopharyngeal Insufficiency and Oronasal Fistula after Primary Palatal Surgery with Sommerlad Intravelar Veloplasty: A Retrospective Study in Isfahan Cleft Care Team","volume":"120","author":"Mapar","year":"2019","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_58","first-page":"e20160146","article-title":"Speech profile of patients undergoing primary palatoplasty","volume":"29","author":"Menegueti","year":"2017","journal-title":"Codas"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.bjps.2007.12.023","article-title":"The Modified Honig Velopharyngoplasty\u2013a New Technique to Treat Hypernasality by Palatal Lengthening","volume":"62","author":"Janssen","year":"2009","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60695-4","article-title":"Cleft Lip and Palate","volume":"374","author":"Mossey","year":"2009","journal-title":"Lancet"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e4019","DOI":"10.1097\/GOX.0000000000004019","article-title":"Cleft Palate Repair: A History of Techniques and Variations","volume":"10","author":"Naidu","year":"2022","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1597\/1545-1569_2003_040_0046_aacaov_2.0.co_2","article-title":"Aerodynamic and Cephalometric Analyses of Velopharyngeal Structure and Function Following Re-Pushback Surgery for Secondary Correction in Cleft Palate","volume":"40","author":"Nakamura","year":"2003","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1343e","DOI":"10.1097\/PRS.0000000000003335","article-title":"What\u2019s New in Cleft Palate and Velopharyngeal Dysfunction Management?","volume":"139","author":"Naran","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/j.ijporl.2014.07.016","article-title":"Speech Outcomes at Age 5 and 10 Years in Unilateral Cleft Lip and Palate after One-Stage Palatal Repair with Minimal Incision Technique\u2013a Longitudinal Perspective","volume":"78","author":"Nyberg","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1111\/1460-6984.12869","article-title":"Longitudinal Data on Speech Outcomes in Internationally Adopted Children Compared with Non-Adopted Children with Cleft Lip and Palate","volume":"58","author":"Okhiria","year":"2023","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/j.ijporl.2005.04.023","article-title":"Hearing and Speech Assessment of Cleft Palate Patients after Palatal Closure. Long-Term Results","volume":"69","author":"Paliobei","year":"2005","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1111\/1460-6984.12036","article-title":"Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Perceptual Outcomes of Velopharyngeal Function","volume":"48","author":"Pereira","year":"2013","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0301-0503(79)80015-6","article-title":"Two-Stage Closure of Cleft Palate (Progress Report)","volume":"7","author":"Perko","year":"1979","journal-title":"J. Maxillofac. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1177\/10556656211025926","article-title":"Speech Outcome and Self-Reported Communicative Ability in Young Adults Born with Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair","volume":"59","author":"Peterson","year":"2022","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1080\/14015439.2017.1390606","article-title":"Speech Outcome in Young Children Born with Unilateral Cleft Lip and Palate Treated with One- or Two-Stage Palatal Repair and the Impact of Early Intervention","volume":"44","author":"Karlsson","year":"2019","journal-title":"Logoped. Phoniatr. Vocol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.bjorl.2020.08.005","article-title":"Speech Outcomes after Palatal Closure in 3\u20137-Year-Old Children","volume":"88","author":"Rezaei","year":"2022","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_72","first-page":"5","article-title":"Treatment Variables Affecting Facial Growth in Complete Unilateral Cleft Lip and Palate","volume":"24","author":"Ross","year":"1987","journal-title":"Cleft Palate J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.bjps.2024.01.034","article-title":"Surgical Treatment of Velopharyngeal Dysfunction: Incidence and Associated Factors in the Swedish Cleft Palate Population","volume":"90","author":"Becker","year":"2024","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_74","first-page":"51","article-title":"The problem of early and late surgery in congenital fissure of the of the lips and palate","volume":"30","author":"Schweckendiek","year":"1951","journal-title":"Z. Laryngol. Rhinol. Otol."},{"key":"ref_75","first-page":"268","article-title":"Primary Veloplasty: Long-Term Results without Maxillary Deformity. a Twenty-Five Year Report","volume":"15","author":"Schweckendiek","year":"1978","journal-title":"Cleft Palate J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1177\/1055665619854632","article-title":"Scandcleft Project, Trial 1: Comparison of Speech Outcome in Relation to Timing of Hard Palate Closure in 5-Year-Olds With UCLP","volume":"56","author":"Willadsen","year":"2019","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1080\/2000656X.2016.1254647","article-title":"Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate: 5. Speech Outcomes in 5-Year-Olds\u2013Consonant Proficiency and Errors","volume":"51","author":"Willadsen","year":"2017","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/1460-6984.12830","article-title":"Scandcleft Randomized Trials of Primary Surgery for Unilateral Cleft Lip and Palate: Speech Proficiency at 10 Years of Age","volume":"58","author":"Willadsen","year":"2023","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1097\/PRS.0000000000000637","article-title":"A Systematic Review Comparing Furlow Double-Opposing Z-Plasty and Straight-Line Intravelar Veloplasty Methods of Cleft Palate Repair","volume":"134","author":"Timbang","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1177\/10556656241239203","article-title":"A Single Institution 19 Year Comparison of Furlow and Straight Line Palatoplasty Techniques in Bilateral Cleft Lip and Palate","volume":"62","author":"Trotter","year":"2024","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1597\/13-121","article-title":"A Cross-Sectional Cohort Study of Speech in Five-Year-Olds with Cleft Palate \u00b1 Lip to Support Development of National Audit Standards: Benchmarking Speech Standards in the United Kingdom","volume":"51","author":"Britton","year":"2014","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1597\/05-164","article-title":"A Cross-Sectional Study of Speech in 10-Year-Old Children with Cleft Palate: Results and Issues of Rater Reliability","volume":"44","author":"Lohmander","year":"2007","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1002\/lary.23839","article-title":"A Longitudinal Study of Hearing and Middle Ear Status in Adolescents with Cleft Lip and Palate","volume":"123","author":"Flynn","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1597\/1545-1569_1996_033_0127_cothho_2.3.co_2","article-title":"Comparison of the Hearing Histories of Children with and without Cleft Palate","volume":"33","author":"Broen","year":"1996","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1597\/08-039.1","article-title":"Methodology for Speech Assessment in the Scandcleft Project\u2014An International Randomized Clinical Trial on Palatal Surgery: Experiences from a Pilot Study","volume":"46","author":"Lohmander","year":"2009","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/02844310510006132","article-title":"Perceptual Analysis of Speech and the Activity in the Lateral Pharyngeal Walls before and after Velopharyngeal Flap Surgery","volume":"39","author":"Lohmander","year":"2005","journal-title":"Scand. J. Plast. Reconstr. Surg. Hand Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1597\/11-202","article-title":"Speech and Language Therapy Interventions for Children with Cleft Palate: A Systematic Review","volume":"50","author":"Bessell","year":"2013","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/02844310600973621","article-title":"Speech Development in Patients with Unilateral Cleft Lip and Palate Treated with Different Delays in Closure of the Hard Palate after Early Velar Repair: A Longitudinal Perspective","volume":"40","author":"Lohmander","year":"2006","journal-title":"Scand. J. Plast. Reconstr. Surg. Hand Surg."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1597\/02-164.1","article-title":"Speech Outcome Following Treatment in Cross-Linguistic Cleft Palate Studies: Methodological Implications","volume":"41","author":"Hutters","year":"2004","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1597\/04-141.1","article-title":"The Cleft Audit Protocol for Speech\u2014Augmented: A Validated and Reliable Measure for Auditing Cleft Speech","volume":"43","author":"John","year":"2006","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Ha, S., Koh, K.S., Moon, H., Jung, S., and Oh, T.S. (2015). Clinical Outcomes of Primary Palatal Surgery in Children with Nonsyndromic Cleft Palate with and without Lip. Biomed. Res. Int., 2015.","DOI":"10.1155\/2015\/185459"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"202","DOI":"10.5999\/aps.2017.44.3.202","article-title":"Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes","volume":"44","author":"Kappen","year":"2017","journal-title":"Arch. Plast. Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1177\/10556656231225575","article-title":"Longitudinal Speech Outcome at 5 and 10 Years in UCLP: Influence of Speech Therapy and Secondary Velopharyngeal Surgery","volume":"62","author":"Persson","year":"2024","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1177\/1055665619888316","article-title":"Scandcleft Project Trial 2-Comparison of Speech Outcome in 1- and 2-Stage Palatal Closure in 5-Year-Olds With UCLP","volume":"57","author":"Nyberg","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1055665619896637","article-title":"Scandcleft Project Trial 3: Comparison of Speech Outcomes in Relation to Sequence in 2-Stage Palatal Repair Procedures in 5-Year-Olds with Unilateral Cleft Lip and Palate","volume":"57","author":"Persson","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jcomdis.2018.01.004","article-title":"Speech Outcomes Following Sommerlad Primary Palatoplasty: Results of the Ghent University Hospital","volume":"72","author":"Bruneel","year":"2018","journal-title":"J. Commun. Disord."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/1460-6984.12508","article-title":"Longitudinal Study of the Development of Obstruent Correctness from Ages 3 to 5 Years in 108 Danish Children with Unilateral Cleft Lip and Palate: A Sub-Study within a Multicentre Randomized Controlled Trial","volume":"55","author":"Willadsen","year":"2020","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2340\/jphs.v58.7317","article-title":"Long-Term Longitudinal Follow-up of Individuals with UCLP after Gothenburg Twostage Palate Closure: Surgical and Speech Outcomes","volume":"58","author":"Mark","year":"2023","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"10556656241274242","DOI":"10.1177\/10556656241274242","article-title":"A Comparative Effectiveness Study of Speech and Surgical Outcomes: Study Overview","volume":"4","author":"Chapman","year":"2024","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00784-024-05828-7","article-title":"Long Term Speech Outcomes after Using the Sommerlad Technique for Primary Palatoplasty: A Retrospective Study in the Wilhelmina Children\u2019s Hospital, Utrecht","volume":"28","author":"Hofman","year":"2024","journal-title":"Clin. Oral. Investig."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1597\/14-141","article-title":"Perceptual-Speech, Nasometric, and Cephalometric Results After Modified V-Y Palatoplasties with or Without Mucosal Graft","volume":"53","author":"Oyama","year":"2016","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Brudnicki, A., Radkowska, E., Sawicka, E., and Fudalej, P.S. (2023). Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175545"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1002\/term.3032","article-title":"Platelet-Rich Plasma Counteracts Detrimental Effect of High-Glucose Concentrations on Mesenchymal Stem Cells from Bichat Fat Pad","volume":"14","author":"Lecce","year":"2020","journal-title":"J. Tissue Eng. Regen. Med."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Gasparro, R., Qorri, E., Valletta, A., Masucci, M., Sammartino, P., Amato, A., and Marenzi, G. (2018). Non-Transfusional Hemocomponents: From Biology to the Clinic\u2014A Literature Review. Bioengineering, 5.","DOI":"10.3390\/bioengineering5020027"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Ramalingam, K., Yadalam, P.K., Ramani, P., Krishna, M., Hafedh, S., Badnjevi\u0107, A., Cervino, G., and Minervini, G. (2024). Light Gradient Boosting-Based Prediction of Quality of Life among Oral Cancer-Treated Patients. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04050-x"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1055\/s-0033-1333883","article-title":"Cleft Palate","volume":"26","author":"Kosowski","year":"2012","journal-title":"Semin. Plast. Surg."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/1817-1737.160831","article-title":"Auscultation of the Respiratory System","volume":"10","author":"Sarkar","year":"2015","journal-title":"Ann. Thorac. Med."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/8\/877\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:43Z","timestamp":1760034463000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/8\/877"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":107,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["bioengineering12080877"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering12080877","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}