Speech Results After Surgical Treatment for Velopharyngeal Dysfunction in Children and Adolescents With Cleft Palate

Objective To investigate degree of speech improvement and adverse effects after secondary velopharyngeal dysfunction (VPD) surgery in individuals with cleft palate with or without cleft lip/alveolus (CP ± L), and to examine whether any patient- or treatment-related factors were associated with treatment efficacy. Design Retrospective intervention study. Setting A regional public care university hospital in Sweden. Patients, Participants Seventy-eight children and adolescents born with CP ± L who had undergone secondary VPD surgery between 2007 and 2024. Interventions Secondary pharyngoplasty or palatoplasty. Main Outcome Measures Blinded pre- and postoperative perceptual assessments by 4 independent speech language pathologists of hypernasality, nasal airflow errors, weak articulation, velopharyngeal competence (VPC), and speech acceptability. Results There were statistically significant improvements by 1 unit in median ratings of all speech variables after VPD surgery. Sixty percent had improved hypernasality, 54% had improved VPC, and 59% had improved acceptability. Of participants with moderate-severe preoperative hypernasality, hypernasality improved for 81%. Odds of improved hypernasality were significantly lower for participants with than without additional conditions (odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.05-0.81). There were no statistically significant associations between odds of improved speech ratings and age at intervention or presence of neurodevelopmental disorders. Conclusions Speech ratings significantly improved after VPD surgery. Hypernasality was more likely to improve for patients with moderate-severe hypernasality than those with mild hypernasality. Hypernasality was also less likely to improve in patients with than without additional conditions. These results can be used to tailor surgical decision making for patients with CP ± L.