Speech Outcomes After Isolated Cleft Palate Repair: Impact of Intravelar Veloplasty and Surgical Technique in 138 Patients

Velopharyngeal insufficiency (VPI) remains one of the most important functional complications after cleft palate repair. Although multiple palatoplasty techniques have been described, the influence of intravelar veloplasty (IVV) on postoperative speech outcomes remains incompletely understood. In this study, we evaluated the impact of different palatoplasty techniques and IVV on postoperative velopharyngeal function in patients with isolated clefts of the secondary palate. A retrospective cohort study of 138 patients with isolated clefts of the secondary palate treated between 2010 and 2023 was performed. The cohort included 99 incomplete and 39 complete cleft palates. Surgical techniques included 4-flap Veau–Wardill–Kilner, 3-flap Veau–Wardill–Kilner, Two-flap palatoplasty (Bardach/Langenbeck), Sommerlad palatoplasty, and Furlow palatoplasty. Velopharyngeal function was assessed using perceptual speech evaluation performed by experienced cleft speech-language pathologists. Statistical analysis was performed using chi-square testing; techniques with very small subgroup frequencies were excluded from subgroup analyses to preserve the validity of chi-square testing. Effect sizes with 95% confidence intervals were calculated for the primary comparison. In incomplete cleft palate patients repaired without anatomical levator reconstruction, statistically significant differences in postoperative VPI frequency were observed among operative techniques ( p = 0.007), with the highest VPI proportion occurring after 4-flap Veau–Wardill–Kilner palatoplasty. Among repairs incorporating anatomical levator reconstruction, no statistically significant technique-related difference was detected, although subgroup sizes were small. Overall, repairs incorporating anatomical levator muscle reconstruction were associated with a lower proportion of postoperative VPI, including both mild and severe forms ( p = 0.0021). These findings support the clinical importance of functional levator muscle reconstruction, while the retrospective design and potential confounding related to surgical technique, surgeon-related factors, and case selection preclude definitive causal interpretation.