A multifaceted investigation of speech outcome after maxillary advancement - PROJECT SUMMARY/ABSTRACT Impaired speech hinders an individual’s ability to effectively communicate in a world that heavily relies on verbal communication. Children born with cleft palate are at high risk of speech disorders directly related to atypical anatomy. In addition, approximately 50% of U.S. adolescents and young adults (AYAs) with cleft palate with or without cleft lip (CP±L) have undergrowth of the upper jaw (maxillary hypoplasia). Maxillary hypoplasia causes an underbite that has detrimental impacts on articulation (i.e., tongue placement for speech). Treatment requires surgery to move the upper jaw forward to align the upper and lower jaws, likely improving articulation. This surgery also changes the anatomic relationship between the soft palate (velum) and back wall of the throat (pharynx), potentially causing velopharyngeal insufficiency (VPI). VPI is a speech disorder caused by inability of the velum to close against the pharyngeal wall and causes air to flow through the nose instead of the mouth when making certain speech sounds. Despite known risk, predictors and prevalence of VPI after forward movement of the upper jaw in AYAs with CP±L are not well understood. Limited evidence exists exploring relative improvement in speech articulation and risk of VPI after upper jaw surgery. Further, data is lacking regarding AYA perception of these risks when making surgical decisions. To address these gaps in knowledge, we propose a prospective cohort study of 50 AYA with CP±L undergoing initial maxillary advancement with the following aims: (1) to investigate anatomic risk factors associated with post-operative VPI, (2) to quantify the relationship between objective or subjective speech measures and patient-reported outcome, (3) to discover AYA perspectives when considering jaw surgery. Results will further illuminate risks and benefits of maxillary advancement surgery on speech and inform future surgical decisions. Candidate: Sara Kinter, PhD is an Assistant Professor, epidemiologist, and speech-language pathologist with the Department of Pediatrics, Division of Craniofacial Medicine at the University of Washington. This award will provide the dedicated time necessary to enhance Dr. Kinter’s skill set for successful transition to an independent investigator. Dr. Kinter’s career development plan includes a combination of didactic, directed, and experiential learning opportunities focused on: (A) objective measurement of speech structure and function, (B) qualitative methods, and (C) leadership, grantsmanship, and dissemination in research. The multi- factorial nature of surgical decision-making as well as the complex relationships between anatomic, functional, and psychosocial perspectives require a principal investigator with extensive clinical experience in this population and a strong background in study design. As a speech-language pathologist with over 15 years of clinical experience who recently earned her Ph.D. in epidemiology, Dr. Kinter is uniquely qualified to carry out this project and address these important, clinically relevant questions. The proposal will provide a strong foundation for future high-impact clinical research aimed at improving speech in individuals with CP±L.
