Outcomes of cleft palatal repair for internationally adopted children

Background:: Families in the United States adopted approximately 230,000 foreign-born children over the past two decades. Age at adoption and the presence of a cleft palate impact speech and language development. The authors' purpose is to document speech outcome after palatal closure in internationally adopted children. Methods:: The authors reviewed internationally adopted children with cleft lip-cleft palate or cleft palate who had two-flap palatoplasty from 1987 to 2010. Data collected included date of birth, cleft palatal type, age at palatoplasty, palatal fistula, postoperative speech assessment, and need for secondary surgery. Results:: The authors identified 55 children adopted with unrepaired cleft palate. Palatal types were Veau I (n = 1), II (n = 1), III (n = 37), or IV (n = 16). Median age at palatoplasty was 25.6 ± 11.8 months; palatal fistula occurred in five patients (9 percent). Speech outcome was successful in 28 patients (51 percent), whereas a secondary operation was recommended for 27 patients (49 percent). Need for a secondary operation was independent of palatal type (p = 0.6). Children who required a pharyngeal flap were significantly older at the time of palatoplasty compared with those who did not (p = 0.009). There was a significant association between increasing age at palatoplasty and need for a secondary operation (OR, 1.07; 95 percent CI, 1.01 to 1.13; p = 0.01). Pharyngeal flap significantly improved speech (p < 0.001). Conclusions:: International adoption with late palatoplasty can result in disordered speech. Velopharyngeal insufficiency is associated with increasing age at palatoplasty. The authors recommend palatoplasty and speech therapy soon after adoption.