Evaluation of Cleft Palate Repair Timing and Speech Outcomes at National Orthopaedic Hospital Enugu

The timing of cleft palate repair is a critical factor influencing postoperative speech development and velopharyngeal function. International consensus generally recommends palatoplasty between 9 and 18 months of age to optimize speech outcomes. In Nigeria, delayed presentation to cleft care centers frequently results in surgery occurring well beyond the optimal window, with consequences for speech development, language acquisition, and social integration. This retrospective cohort study evaluates the relationship between cleft palate repair timing and speech outcomes among children treated at the National Orthopaedic Hospital Enugu, South East Nigeria. Records of 64 children who underwent palatoplasty between 2016 and 2022 were reviewed, with speech assessment data obtained from follow-up evaluations performed by a speech and language therapist at 12 and 24 months post-surgery. Speech outcomes assessed include hypernasality, articulation competency, and velopharyngeal insufficiency using the Pittsburgh Weighted Speech Score. Results indicate that children who underwent palatoplasty before 18 months achieved significantly better speech outcomes at both follow-up time points compared to those operated beyond 24 months. Socioeconomic barriers and distance from cleft care centers were the primary causes of delayed presentation. The study advocates for improved access to cleft care services, community-based case identification programs, and government-funded transport support for families in remote South East Nigerian communities. Keywords: cleft palate, palatoplasty timing, speech outcomes, Enugu, velopharyngeal insufficiency.