Epidemiology, Clinical Aspects and Management of Cleft Lip and/or Palate in Burkina Faso: A Humanitarian Pediatric Surgery-Based Study

Background: Cleft lip and/or palate are the most common orofacial malformations. Many studies, especially in developed countries have been conducted on this malformation, but in Burkina Faso, data are scarce and they are not specific to children. The aim of this study was to report the epidemiological, clinical and therapeutic aspects of cleft lip and/or palate in children in a low-income country. Materials and Method: The authors conducted a retrospective descriptive study based on data of three humanitarian missions of pediatric reconstructive facial surgery which took place in 2007, 2010 and 2014 at Clinique El Fateh-Suka in Ouagadougou, Burkina Faso. All children of 0 - 14 years of age, presenting with cleft lip and/or palate, were included in the study. Results: A total of 185 cases of cleft lip and/or palate were seen during these three humanitarian surgery missions. There were 100 boys and 85 girls. The average age of the children was 2.4 ± 3.2 years [0 - 12 years];there were 8.7% newborns. The commonest type of cleft was cleft lip and palate (49.7%) followed by isolated cleft lip (48.7%) and isolated cleft palate (1.6%). The left side was the most affected (49.2%). In 21.1% of cases, clefts were associated with other congenital malformations. In total, 150 of 185 (81.1%) children underwent surgery and there were no postoperative complications reported. Conclusions: Epidemiological and clinical characteristics of cleft lip and/or palate observed in this study are not very different from those described elsewhere in Africa. However, in our conditions, there are circumstances and structural factors which hinder the diagnosis and constitute challenges that must be addressed for adequate management of this congenital, highly disfiguring malformation.

Postoperative Velopharyngeal Closure Function Following Unified Velopharyngeal Plasty as Secondary Surgery for Cleft Palate: One- and Three-Year Follow-Up Results

Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.

Evaluation of Results of the Furlow’s Modified Technique in the Management of Cleft Palate in the Teaching Hospital of Conakry

Introduction: Cleft palate (CP) is a congenital dysmorphosis that results from a failure of the palatal processes of the maxillary buds and nasal septum to merge. The objectives of this study were to determine the frequency of complications of the modified Furlow technique and to evaluate its anatomical and functional outcomes. Materials and Method: This was a retrospective study that took place over a period of 4 years (from January 1st, 2015 to December 31th, 2018) in the Department of Odontostomatology and Maxillofacial Surgery at the National Hospital of Donka (Conakry, Guinea). Data retrieval consisted of records from patients operated on for cleft palate according to Furlow’s modified technique only. The operative technique consisted of marginal incisions of the cleft according to the technique of the double Z-plasty of Furlow. Subsequently, the defect created between the 2 flaps and the anterior edge of the cleft was filled by two fat masses of Bichat sutured to each other with Vicryl 3-0. Four years after surgery, the patients were recalled for an evaluation of the anatomical and functional results. Results: 13 patients underwent surgical loading according to the modified Furlow technique. The average age of the patients was 6.9 years with an age range of 7 months and 17 years. Females were the most affected, with 61.54% of cases and a sex ratio of 0.62. The primary repair rate was 84.61% of cases. Immediate operative follow-up was simple with epithelialization of the flaps in all patients. Four (4) years after the surgeries, 12 patients were reevaluated (92.30%), among them one case (8.33%) of fistula complication was noted. The mobility of the veil and the phonation were good in 85.71% and 60% respectively. Articular disorders with nasonation were found in 2 patients (16.67%). Swallowing was normal in 85.72% of cases. Conclusion: The modified Furlow technique is an important contribution to cleft palate surgery significantly reducing the occurrence of postoperative complications. However, the delay of the surgical operation remains a real obstacle for obtaining a normal phonation.

Assessment of Two Years of Free Surgical Treatment of Cleft Lip, Palate and Alveolar (CLPA) in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan

Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the upper lip, the alveolar bone and the palate. The incidence in Africa ranges from 1/2000 to 1/500 births. Their multidisciplinary management is long and costly. Thus, the help provided by humanitarian organisations during free care campaigns is welcome. Materials and Methods: This is a retrospective descriptive study conducted from August 2014 to July 2016 in the Maxillofacial Surgery and Stomatology Department of the Treichville University Hospital in Abidjan, Côte d’Ivoire. The objective was to describe the epidemiological, clinical and therapeutic aspects of CLPA during a humanitarian campaign for free care. Results: 51 cases of CLPA were operated on. Males were involved in 54.9% of the cases, i.e. a sex ratio of 1.2. The average age of the patients at the time of the operation was 3.44 years with extremes of 3 months and 52 years. Patients with low socioeconomic status represented 84.3% of the cases. Cleft lips (31.4%) and cleft palates (33.33%) predominated. For cleft lips, unilateral forms were the most frequent (73.5%) and the left side was most often affected (59.2%). The most common surgical techniques used were MILLARD cheiloplasty for cleft lips (79.36%) and Dorrance pushback for cleft palates (78.05%). The postoperative course was simple in the majority of cases (80.47%). Patients and/or parents were satisfied with the postoperative results in over 90% of cases. Discussion: Cleft lip and palate are common. Their management by humanitarian missions through mass campaigns allows us to receive a large number of patients affected by this pathology who are treated with a high satisfaction rate. Conclusion: The characteristics of cleft lip and palate in this study are in many respects identical to those described in the literature, but with some differences specific to Africa, notably the absence of antenatal diagnosis and the advanced age at the time of treatment.

Ultrastructural and element spectrometric analysis of distraction osteogenesis for reconstruction of cleft palate in rhesus macaque model

Objective To study the ultrastructure and Ca/P clement spectrometry of distraction osteogenesis(DO) for reconstruction of cleft palate(CP),so as to explore the osteogenesis and remodeling of new bone in situ.Methods 23 rhesus macaques

The Craniofacial Morphology in Adult Patients with Unoperated Isolated Cleft Palate

Objective： To address the effect of intrinsic factors on craniofacial growth by analyzing the craniofacial morphology of unoperated isolated cleft palate in Chinese adult. Materials and Methods： This study included 37 nonsyndromic isolated cleft palate and 39 age and gender matched non-clefts. Twenty-six cephalometric measurements were employed to evaluate the facial morphology. Independent samples T test and Mann- Whitney U were used for comparison. Significant difference was defined at 95% level. Results： Data from this study showed patients with unoperated isolated cleft palate have a reduced maxillary sagittal length （ANS-PMP, A-PMP, P〈0.05）, a smaller ANB angle （ANB, P〈0.05） and a retrusive ANS point （S-N-ANS, P〈0.05; Ba-N-ANS, P〈0.05）. Measurements descripted position of maxilla （S-Ptm, P〉0.05）, depth of bony pharynx （Ba-PMP, P〉0.05）, anterior and posterior maxillary height （N-ANS, P〉0.05; R-PMP, P〉0.05） and mandible morphology （including linear measurements and angle measurements） did not show any significant difference between case and control groups. Conclusions： Patients with isolated cleft palate were characterized by maxillary retrusion. Mandible morphology and cranial basal morphology in isolated cleft palate showed no significant difference with nonclefts. Patients with isolated cleft palate are more vulnerable to cross bite than nonclefts. Intrinsic deficiencies did detrimental effect on maxilla sagittal length, but did no detrimental effect on maxilla position, mandible size and position.

Accurate diagnosis of prenatal cleft lip/palate by understanding the embryology

Cleft lip with or without cleft palate(CP) is one of the most common congenital malformations. Ultrasonographers involved in the routine 20-wk ultrasound screening could encounter these malformations. The face and palate develop in a very characteristic way. For ultrasonographers involved in screening these patients it is crucial to have a thorough understanding of the embryology of the face. This could help them to make a more accurate diagnosis and save time during the ultrasound. Subsequently, the current postnatal classification will be discussed to facilitate the communication with the CP teams.

BHMT Gene Polymorphisms as Risk Factors for Cleft Lip and Cleft Palate in a Chinese Population

Objective Convincing evidence suggests a link between increased risk of nonsyndromic cleft lip with or without cleft palate （NSCL/P） and low intake of folic acid by the mother during pregnancy. The present study was designed to explore if genetic variation in the betaine‐homocysteine methyltransferase （BHMT） gene contributes to NSCL/P. Methods DNA was obtained from 166 individuals with NSCL/P and 285 healthy subjects. Three known single nucleotide polymorphisms （SNPs） present in the BHMT gene （rs651852, rs3797546, and rs3733890） were investigated by real‐time PCR‐based TaqMan genotyping. Results Neither allelic nor genotypic association was found between NSCL/P and SNPs rs651852 and rs3733890. SNP rs3797546 did not show allelic association with NSCL/P; however, a higher proportion of NSCL/P patients carry the CC genotype compared with the TT＋CT genotype （P=0.020, OR=2.10, 95% CI=1.11‐3.95）. Conclusion Our study suggests that polymorphism rs3797546 in the BHMT gene may confer genetic risk of NSCL/P in a recessive manner.

RETINOIC ACID DOWN-REGULATES BONE MORPHOGENETIC PROTEIN 7 EXPRESSION IN RAT WITH CLEFT PALATE

Objective To evaluate the effects of retinoic acid （RA） on expression of bone morphogenetic protein 7 （ BMP-7 ） in rat fetus with cleft palate, and the effects of RA on proliferation and apoptosis of osteoblasts. Methods All-trans RA （ATRA） was used to induce congenital cleft palate in Wistar rat. BMP-7 mRNA expression in maxillary bone tissue of fetal rats was measured by Northern blotting analysis. Flow cytometry and MTF assay were used to measure the apoptosis and proliferation of ATRA-treated MC-3T3-E1 cells. BMP-7 mRNA and protein expressions in ATRA-treated MC-3T3-E1 cells were detected by RT-PCR and Western blotting analysis. Remilts ATRA could induce cleft palate of rat fetus. The incidence rate of cleft palate induced by 100 mg/kg AT-RA （45.5%） was significantly higher than 50 mg/kg ATRA （ 12.5%, P 〈 0. 05 ）. BMP-7 mRNA expression decreased in maxillary bone tissue of rat fetus with cleft palate. MC-3T3-E1 cells proliferation treated with 1 × 10^-6 mol/L ATRA decreased by 60%, the cell apoptosis increased by 2 times. BMP-7 mRNA and protein levels in MC-3T3-E1 cells treated with 1 × 10^-6 mol/L ATRA decreased by 60% and 80%, respectively, compared with ATRA-untreated cells （ P 〈 0.05 ）. Conclusions BMP-7 may play an important role in embryonic palate development. RA may possess the ability to down-regulate cell proliferation through regulation of BMP-7 gene expression.

Genome-wide and Interaction Linkage Scan for Nonsyndromic Cleft Lip with or without Cleft Palate in Two Multiplex Families in Shenyang,China

Objectives To identify the loci involved in nonsyndromic cleft lip with or without cleft palate （NSCL/P） in Northern Chinese people in Shenyang by using genomewide and interaction linkage scan.Methods Two multiplex families in Shenyang from North China were ascertained through probands with NSCL/P.Blood of every member was drawn for DNA extraction and analysis.Genotypes were available for 382 autosomal short tandem repeat （STR） markers from the ABI Prism Linkage Mapping Set version 2.5.Linkage between markers and NSCL/P was assessed by 2-point parametric LOD scores,multipoint heterogeneity parametric LOD scores （HLODs）,and multipoint nonparametric linkage score （NPL）.Results The initial scan suggested linkage on Chromosomes 1,2,and 15.In subsequent fine mapping,1q32-q42 showed a maximum multipoint LOD score of 1.9（empirical P=0.013） and an NPL score of 2.35 （empirical P=0.053）.For 2p24-p25,the multipoint NPL increased to 2.94 （empirical P=0.007）.2-locus interaction analysis obtained a maximum NPL score of 3.73 （P=0.00078） and a maximum LOD score of 3 for Chromosome 1 （at 221 cM） and Chromosome 2 （at 29 cM）.Conclusion Both parametric and nonparametric linkage scores greatly increased over the initial linkage scores on 1q32-q42,suggesting a susceptibility locus in this region.Nonparametric linkage gave a strong evidence for a candidate region on chromosome 2p24-p25.The superiority of 2-locus linkage scores compared to single-locus scores gave additional evidence for linkage on 1q32-q42 and 2p24-p25,and suggested that certain genes in the two regions may contribute to NCSL/P risks with interaction.

LncR NA H19 and Target Gene-mediated Cleft Palate Induced by TCDD

This study investigated the role of long non‐coding RNAs（lnc RNAs） in the development of the palatal tissues. Cleft palates in mice were induced by 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin（TCDD）. Expression levels of long non‐coding RNA H19（lncR NA H19） and insulin‐like growth factor 2（IGF2） gene were measured by quantitative real‐time polymerase chain reaction（q RT‐PCR）. The rate of occurrence of cleft palate was found to be 100% by TCDD exposure, and TCDD could cause short upper limb, cerebral fissure, webbed neck, and short neck. The expression levels of lnc RNA H19 and IGF2 gene specifically showed embryo age‐related differences on E13, E14, and E15 in the palatal tissues. The expression levels of lnc RNA H19 and IGF2 gene showed an inverse relationship on E13, E14, and E15. These findings demonstrated that lnc RNA H19 and IGF2 can mediate the development of mouse cleft palate.

Molecular basis of cleft palates in mice

Cleft palate, including complete or incomplete cleft palates, soft palate clefts, and submucosal cleft palates, is the most frequent congenital craniofacial anomaly in humans. Multifactorial conditions, including genetic and environmental factors, induce the formation of cleft palates. The process of palatogenesis is temporospatially regulated by transcription factors, growth factors, extracellular matrix proteins, and membranous molecules; a single ablation of these molecules can result in a cleft palate in vivo. Studies on knockout mice were reviewed in order to identify genetic errors that lead to cleft palates. In this review, we systematically describe these mutant mice and discuss the molecular mechanisms of palatogenesis.

AN ANALYSIS OF ACOUSTIC CHARACTERISTICS OFCLEFT PALATE SPEECH WITH COMPUTERIZED SPEECH SIGNAL PROCESSING SYSTEM

The acoustic characteristics or the chinese vowels of 24 children with cleft palate and 10 normal control children were analyzed by computerized speech signal processing system (CSSPS),and the speech articulation was judged with Glossary of clert palate speech(GCPS).The listening judgement showed that the speech articulation was significantly different between the two groups(P<0.01).The objective quantitative measurement suggested that the formant pattern(FP)of vowels in children with cleft palate was different from that of normal control children except vowel[a](P< 0.05).The acoustic vowelgraph or the Chinese vowels which demonstrated directly the relationship of vocal space and speech perception was stated with the first formant frequence(F1)and the second formant frequence(F2).The authors conclude that the values or F1 and F2 point out the upward and backward tongue movement to close the clert, which reflects the vocal characteristics of trausmission of clert palate speech.

Perioperative Management of Cleft Palate Repair in a Patient with Williams Syndrome: A Case Report

The Background: Williams syndrome is a neurodevelopmental multisystem genetic disorder characterized by dysmorphic features and a wide range of congenital cardiac, renal, musculoskeletal anomalies. Presence of cleft palate in these patients is an unusual condition. More than 22 cases of sudden cardiac death reported in literature especially during anesthetic management in the patients of Williams syndrome. So these patients present major perioperative challenges to anesthesiologist. The authors report successful anesthetic care for repair of cleft palate in presence of uncorrected patent ductus arteriosus (PDA) and mild supraventricular aortic stenosis (SVAS) in a 3.5-year-old female child diagnosed with Williams syndrome. Case report: Diagnosed case of Williams syndrome with characteristic facial dysmorphic features, SVAS and rare malformation of PDA, was scheduled for cleft palate repair. After keen preoperative assessment, general anesthesia was administered for the procedure with continuous monitoring for vital parameters. Because of dysmorphic features, difficulty was faced during intubation. Otherwise intraoperative procedure was uneventful. Postoperative analgesia was managed with intravenous paracetamol. Conclusion: Being a multisystem disorder, each patient of WS requires meticulous preoperative evaluation and high level of intraoperative and postoperative continuous monitoring regardless of any surgical procedure. Surgical correction of cleft palate in such patients demands very high anesthetic and surgical skills as both share common airway. Present case report highlights the significance of aggressive perioperative management in WS which can result in successful outcome.

A Case-control Study of Environmental Risk Factors for Nonsyndromic Cleft of the Lip and/or Palate in Xuzhou,China

In this study, we sought to determine the association between environmental factors and nonsyndromic cleft of the lip and/or palate （NSCLP） to understand the etiology of the disease. A total of 200 NSCLP cases and 327 controls were recruited at the Maternal and Child Health Hospital of Xuzhou City. We conducted face-to-face interviews with the mothers of both cases and controls. The factors increasing the risk of NSCLP were a positive family history [odds ratio （OR）=56.74], pesticide exposure （OR=8.90）, and indoor decoration pollution （OR= 4.32）. On the other hand, the factors decreasing the risk of NSCLP were a high education level （OR=0.22） and supplementation of folic acid （OR=0.23） and multivitamins （OR=0.16）. Positive family history, pesticide exposure, and indoor decoration pollution are associated with the risk of NSCLP. In contrast, high education level and folic acid and multivitamin supplementation are protective factors against NSCLP.

Comparison of Congenital Tooth Deficiencies Seen in Permanent Teeth in Individuals with Unilateral Cleft Lip and Palate to Those without Cleft Lip and Palate

Objective: To compare the congenital tooth deficiencies seen in permanent dentition in individuals with unilateral cleft lip and palate (UCLP) to non-cleft individuals with Angle Class I malocclusion. Method: The study was performed on orthopantomograph films of 50 individuals with UCLP aged between 12 - 16 years and 50 individuals with Angle Class I malocclusion individuals aged between 13 - 15 years. Individuals with UCLP;32 clefts were on the left side and 18 clefts were on the right side. Permanent third molar teeth deficiency was excluded from the study. Results: In 50 individuals with UCLP;35 (70%) upper lateral incisors were congenitally deficient in the cleft area, while 15 (30%) missing lateral teeth were found in the non-cleft side. In control group, 12 (24%) of 50 patients had congenital lateral incisor deficiency. Congenital deficiency of upper lateral incisor in UCLP;the cleft area was higher than the non-cleft side (p < 0.01). The difference was statistically important when compared with the control group (p < 0.001). In 50 individuals with UCLP;while 27 (54%) of second premolar teeth were congenitally deficient in cleft side, 23 (46%) were missing in non-cleft side. In control group, 18 (36%) congenital second premolar deficiency was detected. However, second premolar congenital deficiency was higher in UCLP group when compared to control group (p < 0.01). Conclusion: The deficiency of the lateral incisors in the cleft side is more often congenitally deficient than upper second premolar teeth and this should be considered in the treatment planning from an early age.

Effect of Cleft Lip and Palate Repair on Craniofacial Morphology in Patients with Unilateral Complete Cleft Lip and Palate.

目的 :通过对替牙期正常儿童及单侧完全唇腭裂 (UCLP)患者X线头影测量侧位片进行比较研究 ,了解唇腭裂及其手术对颌骨发育的影响 ,探索继发畸形的发病机制。方法 :将替牙期的正常儿童及UCLP患者分为四组 :①正常对照组 (Normal) ,本组包括 48名替牙期正常湖北地区儿童 ;②未手术组 (NO) ,本组 10名UCLP患者未经任何手术治疗 ;③唇裂修复组 (OL) ,34名UCLP患者已行唇裂修复 ,腭裂暂未手术 ;④唇腭裂修复组 (OLP) ,16名UCLP患者已行唇、腭裂修复。各受试对象拍摄X线头影测量侧位片 ,测量描述颌骨的形态特征及生长方向 ,对各组之间测量结果进行统计学分析。结果 :未行手术治疗的U CLP患者颌骨形态除腭部先天性发育不足外 ,颌骨侧位头影测量与正常无显著性差异 ;OL和OLP组较正常存在严重的颌骨畸形 ,主要表现为上颌后缩、位置后移 ,同时下颌骨向后下旋转移位 ;OL和OLP组上颌后缩的程度无显著性差异。结论 :UCLP患者颌骨具有趋于发育正常的生长能力 ;手术是导致颌骨继发畸形的主要因素 ;对于单侧完全唇腭裂患者 。

Malonylcarnitine in Newborns with Non-syndromic Cleft Lip with or without Cleft Palate

Aim Malonyl-CoA is regarded as a key signaling molecule in mammalian ceils. It is converted to acetyl-CoA, and to a lesser extent, to malonyl acid and malonylcamitine （C3DC）. Availability of carnitine has been reported to be essential for the developing fetus. The objectives of the present study were to analyze associations of malonylcarnitine, acetylcarnitine （C2）, and free carnitine （CO） in subjects with orofacial clefts. Methodology We performed a retrospective analysis of carnitine concentration obtained from a newborn screening program carried out in our institution. Concentrations of whole blood malonylcarnitine, acetylcarnitine, and free carnitine were measured using tandem mass spectrometry. The study group consisted of 51 children with nonsyndromic cleft lip with or without cleft palate. In total, 106 healthy children without congenital anomalies served as controls. Cut-off points were established using likeli-hood ratio values. Results The mean concentration of malonylcarnitine in the cleft group was lower than that of the control group, 0.048 μmol.L^1 vs. 0.058 μmol.L^-1, respectively （P=-0.009）. In patients with orofacial cleft, low malonylcarnitine levels （〈0.047 μmol.L-1） were 1.7 times more predominant than in healthy individuals （P=-0.03）. The mean concentration of acetylcarnitine was also lower in affected newborns in comparison to controls, 33.8 μol.L^-1 vs. 37.8 μmol·L^-1, respectively （P=-0.026）. After analysis of acetylearnitine and free carnitine concentrations, the likelihood ratio test did not indicate valuable cut-offpoints. Conclusion The study provides initial data indicating a potential association between decreased malonylcarnitine and abnormal palatogenesis.

Successful treatment of congenital palate perforation: A case report

BACKGROUND Congenital palate perforation is extremely rare. There is controversy about its exact etiology and appropriate management. Here, a case of congenital palatal perforation is reported. The diagnosis and treatment of the disease are summarized.CASE SUMMARY A full-term neonate boy was referred for oral and craniomaxillofacial surgery with a finding of a hole in the palate at birth. The operation was postponed after pediatric consultation because of the patient’s poor nutrition and underweight for his age. At the age of 10 mo, the patient underwent modified von Langenbeck palatoplasty. He was followed for four years after surgery without any signs of re-rupture. His speech was satisfactory.CONCLUSION Considering the anatomy and etiology, congenital palate perforation can be classified as isolated or associated with submucous cleft palate, and the treatment procedure should be altered accordingly.

Value of acoustic perceptual method for analysis of compensatory articulation errors in postoperative patients with cleft palate

Objective To establish an acoustic perceptual method analyzing the compensatory articulation errors in children with operated cleft palate via the formants of Chinese pure vowels. Methods The first three formants which represent vocal transmission character in Chinese pure vowels of 84 subjects with operated cleft palate, were measured by Computerized Speech Signal Processing System (CSSPS). The Chinese vowel graph of postoperative patients with cleft palate was stated by the first formant frequencies (F1) and the second formant frequencies (F2) of the Chinese pure vowels between the two groups. Results Values of F1 and F2 of vowels except [a] in the poor articulation group (Group A) were significantly different from those in the good articulation group (Group B) (P<0.05 or P<0.01). As compared with that in Group B, the vowel graph demonstrated the decreased perceptual distances in Group A. These findings indicated that there might still be the backward movements of tongue, perverted mandibular movements and disharmonious lip movements in addition to the velopharyngeal insufficiency (VPI) in Group A. Conclusion The speech articulation of children with repaired cleft palate should be gained by correcting the aberrant compensatory articulation errors in the condition of velopharyngeal competence. Computerized Speech Signal Processing System (CSSPS), which is regarded as the content of objective quantitative measurement, is a precise, simple, reliable and atroumatic technique for children with cleft palate to analyze pathological compensatory articulation errors.