Tracking VELO Outcomes: More Work to Be Done After Surgery

BACKGROUND: Children with cleft palate may develop velopharyngeal insufficiency (VPI), reducing speech clarity and affecting daily life. Patient- and caregiver-reported measures complement clinic-based speech ratings. AIM: To describe quality-of-life and speech intelligibility outcomes in children with cleft palate and VPI across 3 groups: preoperative (planning VPI surgery), postoperative (after VPI surgery), and nonoperative (managed without surgery). METHODS: Retrospective chart review at a tertiary center of children completing the velopharyngeal insufficiency effects on life outcomes (VELO) questionnaire after local implementation (mid-2024). Groups were preoperative surgical (n=6), postoperative surgical (n=26), and nonoperative (n=31). Outcomes were caregiver VELO (total/domains), child/youth VELO when available (≥8 years), and caregiver-rated speech intelligibility using the Intelligibility in Context Scale (ICS). RESULTS: All 63 patients had caregiver VELO; child/youth VELO was available for 28 encounters. Median ICS was 3.0 (preoperative), 4.0 (postoperative), and 4.0 (nonoperative). Median caregiver VELO total was 50.0 (preoperative) versus 72.1 (postoperative and nonoperative). Lowest (most affected) domains were speech limitation and difficulty speaking in certain situations; swallowing was generally least affected. Median child/youth VELO total was 41.3 (preoperative; n=1), 70.1 (postoperative), and 85.9 (nonoperative). Postoperative patients most commonly underwent superiorly based pharyngeal flap (42%); median time from surgery to survey was 8 months. CONCLUSION: Quality of life improved after VPI surgery compared with preoperative patients, but speech-related limitations persisted and remained the most affected domains. Prospective, longitudinal studies are needed to define optimal postoperative supports (eg, targeted speech therapy) to address residual communication challenges.