Symptoms of dysphagia in children with cleft lip and/or palate pre- and post-surgical correction

Freitas, Jordana da Silva; Cardoso, Maria Cristina de Almeida Freitas

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Original Article • CoDAS 30 (1) • 2018 • https://doi.org/10.1590/2317-1782/20182017018 copy

Symptoms of dysphagia in children with cleft lip and/or palate pre- and post-surgical correction

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

Determine the occurrence of dysphagia symptoms in children with cleft lip and/or palate (CLP) pre- and post-surgical correction.

Methods

Quantitative observational cross-sectional study. Existence of clef lip and/or palate without association with other syndromes was the study inclusion and/or exclusion criterion. Parents and/or legal guardians responded to a recall questionnaire on the identification of occurrence of coughing, choking, vomiting, and nasal escape pre- and postoperatively and whether these symptoms disappeared after surgical correction. The study was approved by the Research Ethics Committee of the aforementioned Institution under protocol no. 1573164.

Results

The sample comprised 23 children with mean age of 48 months, mostly male and with unilateral trans-foramen incisor clefts. Statistically significant difference was observed between the pre- and post-surgical periods regarding the presence of dysphagia symptoms.

Conclusion

Surgical treatment of patients with cleft lip and/or palate proved to be a resource to prevent the occurrence of dysphagia symptoms when associated with adequate intervention chronology.

Keywords
Swallowing; Deglutition Disorders; Cleft Lip; Cleft Palate; Surgery

Surgical Variables	n (%)
Cheiloplasty	16
0-3 Months	4 (25.0%)
4-6 Months	3 (18.8%)
7-12 Months	5 (31.3%)
>12 Months	4 (25.0%)
Palatoplasty	17
Up to 18 Months	12 (70.6%)
19-24 Months	3 (17.6%)
>24 Months	2 (11.8%)

Variables	n (%)
Has received information about posture and general feeding	n=23
Yes	18 (78.3%)
No	5 (21.7%)
Informing professional	n=18
Speech-language pathologist	8 (44.4%)
Physician	9 (50.0%)
Others	1 (5.6%)
When the information was received
During the term of pregnancy	0 (0.0%)
At the maternity hospital	9 (50.0%)
During the postpartum follow-up	5 (27.8%)
After clinical care	4 (22.2%)

Variables	n=23
Symptoms with liquid consistency	n (%)
Choking	13 (56.5%)
Coughing	12 (52.2%)
Vomiting	10 (43.5%)
Nasal escape	21 (91.3%)
Symptoms with pasty consistency	n (%)
Choking	8 (34.8%)
Coughing	9 (39.1%)
Vomiting	4 (17.4%)
Nasal escape	20 (87.0%)
Symptoms with solid consistency	n (%)
Choking	9 (39.1%)
Coughing	9 (39.1%)
Vomiting	4 (17.4%)
Nasal escape	16 (69.6%)

Variables	Before (n=23)	After (n=20)	p ^* * McNemar’s test
Nasal escape	22 (95.7)	2 (8.7)	<0.001
Choking	13 (56.5)	1 (5.0)	0.002
Coughing	14 (60.9)	0 (0.0)	0.001
Vomiting	10 (43.5)	1 (5.0)	0.004

Signs and Symptoms of Dysphagia	Unilateral trans-foramen incisor (n=13)	Bilateral trans-foramen incisor (n=3)	Incomplete pre-foramen incisor (n=2)	Complete post-foramen incisor (n=1)	Incomplete post-foramen incisor (n=4)	p ^* * Monte Carlo simulation for Fisher's exact test
Signs and Symptoms of Dysphagia	n (%)	n (%)	n (%)	n (%)	n (%)	p ^* * Monte Carlo simulation for Fisher's exact test
Before
Nasal escape	13 (100)	3 (100)	1 (50)	1 (100)	4 (100)	0.127
Choking	5 (38.5)	2 (66.7)	2 (100)	1 (100)	3 (75.0)	0.318
Coughing	5 (38.5)	3 (100)	1 (50)	1 (100)	4 (100)	0.053
Vomiting	7 (53.8)	0 (0.0)	2 (100)	0 (0.0)	1 (25.0)	0.408
After
Nasal escape	2 (15.4)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1.000
Choking	1 (7.7)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1.000
Coughing	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	-
Vomiting	1 (7.7)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1.000

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[1] Conflict of interests: nothing to declare.