Orofacial Strength and Functions in Filipino Adults With Delayed Palatal (and Lip) Closure

Untreated cleft lips and palates are common in developing countries and patients do often not present to surgeons until they reach adolescence or adulthood. Consequently, delayed primary palatal and lip closure is frequently performed in low- and middle-income countries. Unfortunately, the effects of delayed primary closure remain largely unknown. The limited studies available focus almost exclusively on speech outcomes. However, other important orofacial functions such as breathing, chewing, and swallowing as well as the overall functioning of perioral muscles can be affected in patients with CP±L.

This study examined orofacial myofunctional outcomes in 19 Filipino adults (mean age = 22.4 years, SD = 4.47) with CP±L who underwent delayed primary palatal closure, with (n=10) or without (n=9) early or delayed lip closure. Assessments were compared with a control group (mean age = 19.2 years, SD = 0.98) without CP±L.

The findings indicated poorer orofacial myofunctional outcomes in patients with CP±L who underwent delayed primary palatal closure in comparison to healthy controls. Significantly lower scores for appearance and posture, mobility and functionality of oropharyngeal structures, as well as weaker tongue and lip muscle strength were observed in the CP±L group. Comparison of individuals with early lip closure, delayed lip closure and non-affected controls revealed notably lower total OMES scores for both the early and delayed lip closure group compared to controls. The delayed lip closure groups showed reduced mobility and functionality of the oropharyngeal structures as well as reduced lip and anterior tongue strength compared to the control group. These specific oromyofunctional disorders were not observed in the early lip closure group.

In conclusion, patients with CP±L who underwent delayed primary palatal closure show more orofacial myofunctional disorders than healthy controls. Additionally, delayed lip closure was associated with more severe myofunctional disorders compared to early lip closure. These results suggest incomplete restoration of perioral muscles and functions after delayed palatal and/or lip repair. Since delayed closure remains common in low- and middle-income countries, future research should explore the potential benefits of oromyofunctional therapy in improving functional outcomes for these patients.