Velopharyngeal Insufficiency in Submucous Cleft Palate: Importance of Combined Surgical Cleft Palate Repair and Dedicated Speech Therapy

OBJECTIVE: This retrospective study aimed to evaluate the different conservative (ie, speech therapy) and surgical treatment approaches of velopharyngeal insufficiency (VPI) associated speech pathology in patients with submucous cleft palate (SMCP), performed within a single tertiary cleft care centre. PATIENTS, PARTICIPANTS: Thirty-three patients treated for SMCP between January 1999 and December 2023, registered in a database of the Maastricht University Medical Centre and MosaKids Children's Hospital and a database of the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA), were included. MAIN OUTCOME MEASURES: The decrease in VPI-associated speech pathology after treatment was retrospectively scored using the Cleft Audit Protocol for Speech-Augmented (CAPS-A) in the Dutch language, based on the Dutch Cleft Speech Evaluation Test (DCSET). RESULTS: A significant reduction of the sum scores of the CAPS-A Dutch was seen in surgery combined with speech therapy (95% CI: 1.46-4.19) and speech therapy after surgery (95% CI: 0.85-3.48). Speech therapy only lowered the sum scores, but did not show a significant effect (95% CI: -1.30 to 1.30). Both surgical and conservative treatment resulted in a reduction of VPI-associated speech pathology, but only surgery significantly reduced hypernasality (P=0.005) and improved speech intelligibility (P=0.005). CONCLUSION: This study confirms the need for a multimodal treatment approach for VPI in SMCP by combining surgical cleft palate repair with pre- and post-operative specialised cleft speech therapy for optimal speech outcomes.