Chewing with a cleft palate: a randomized controlled trial. Effect of timing of surgical closure of the palate on mastication in infants with clefts.

Abstract

Abstract Objectives- To evaluate the timing of surgical closure of the palate on overall masticatory function in infants with cleft lip- and/or palate (CL/P). Materials and Methods- We performed a two-arm longitudinal observational study including 60 children with CL/P treated by the cleft-team in the Wilhelmina Children’s Hospital, University Medical Center Utrecht, The Netherlands. The study population was divided in two groups based on timing of the palatal closure at respectively 6-8 (group A) and 10-12 (group B) months of age. Measurement was performed at the age of 9, 13 and 17 months using the Mastication Observation and Evaluation (MOE) instrument, which scored the tongue protrusion, lateral tongue movement, munching, jaw movement, chewing duration, loss of food or saliva, number of swallows, fluency and coordination of chewing in all subjects. Results- There was no statistically significant difference in total MOE score between group A and B. Group B performed significantly better regarding lateral tongue movement at the age of 17 months in comparison to individuals with early palatal closure (group A mean = 2.45; SD = 0.506, group B mean = 2.72; SD = 0.528). Conclusions- Early palatal closure does not result in a better overall masticatory function in children with CL/P at the age of 9, 13 and 17 months, when assessed with the MOE instrument. Clinical Relevance- Study’s that investigate the overall mastication performance in children with CL/P are lacking. Our study is the first to evaluate this treatment outcome regarding the timing of palatoplasty. Trial Registration Number The CLEFED study was approved by the Medical Ethics Committee of the University Medical Center Utrecht, The Netherlands (registration no: NTR3275). Date of registration: November 2011