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Sun, Oct 25, 2026
Volume 24, Issue 3 (September 2026)
Iranian Rehabilitation Journal 2026, 24(3): 321-332 |
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Tavakoli M, Rezaei P, Tahmasebifard N, Abdali H, Derakhshandeh F. Perceptual Speech Outcomes and Videofluoroscopic Findings After Radical Intravelar Veloplasty. Iranian Rehabilitation Journal 2026; 24 (3) :321-332
URL: http://irj.uswr.ac.ir/article-1-2685-en.html
URL: http://irj.uswr.ac.ir/article-1-2685-en.html
1- Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2- Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. & Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
3- Saint Mary’s College, Notre Dame, United States of America. & Cleft Palate Team, Department of Plastic Surgery, University of California Irvine Medical Center, Orange, United States of America.
2- Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. & Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
3- Saint Mary’s College, Notre Dame, United States of America. & Cleft Palate Team, Department of Plastic Surgery, University of California Irvine Medical Center, Orange, United States of America.
Abstract: (1924 Views)
Objectives: Velopharyngeal (VP) insufficiency is a persistent complication after primary palatoplasty that adversely affects speech. Radical intravelar veloplasty (IVVP) has been proposed as a secondary reconstructive technique to restore VP function. This study aimed to evaluate speech outcomes and VP closure following radical IVVP in patients with non-syndromic cleft palate.
Methods: This retrospective audit comprised 94 patients who underwent perceptual speech evaluations pre- and postoperatively. Parameters assessed included hypernasality (HN), audible nasal emission (ANE), and non-oral errors (NOEs). In a subgroup of 53 patients, single-view lateral videofluoroscopy was used to measure the VP closure ratio (VPCR). Statistical analyses were performed using Wilcoxon and paired t-tests, and ordinal logistic regression (P<0.05).
Results: Postoperative assessments at a minimum of 6 months (median follow-up: 15 months) demonstrated significant reductions in HN (P<0.001, r=0.65), ANE (P=0.001, r=0.33), and NOE (P<0.001, r=0.43). VPCR improved significantly (from 0.48 to 0.7, P<0.001, r=0.07), and complete closure was achieved in 13 patients. The fistula rate decreased significantly from 21.2% to 7.4% (P=0.002). The ordinal logistic regression model indicated that Preoperative NOEs (β=−1.59, odds ratio [OR]=0.2, P=0.02), age at surgery (β=0.08, OR=1.08, P=0.04), and postoperative VPCR (β=−0.29, OR=0.75, P=0.05) were statistically significant predictors of the outcome (All P≤0.05).
Discussion: Radical IVVP achieves significant functional improvement across key speech parameters and VP function in appropriately selected cleft palate patients. However, VPCR alone is insufficient to fully predict resonance outcomes.
Methods: This retrospective audit comprised 94 patients who underwent perceptual speech evaluations pre- and postoperatively. Parameters assessed included hypernasality (HN), audible nasal emission (ANE), and non-oral errors (NOEs). In a subgroup of 53 patients, single-view lateral videofluoroscopy was used to measure the VP closure ratio (VPCR). Statistical analyses were performed using Wilcoxon and paired t-tests, and ordinal logistic regression (P<0.05).
Results: Postoperative assessments at a minimum of 6 months (median follow-up: 15 months) demonstrated significant reductions in HN (P<0.001, r=0.65), ANE (P=0.001, r=0.33), and NOE (P<0.001, r=0.43). VPCR improved significantly (from 0.48 to 0.7, P<0.001, r=0.07), and complete closure was achieved in 13 patients. The fistula rate decreased significantly from 21.2% to 7.4% (P=0.002). The ordinal logistic regression model indicated that Preoperative NOEs (β=−1.59, odds ratio [OR]=0.2, P=0.02), age at surgery (β=0.08, OR=1.08, P=0.04), and postoperative VPCR (β=−0.29, OR=0.75, P=0.05) were statistically significant predictors of the outcome (All P≤0.05).
Discussion: Radical IVVP achieves significant functional improvement across key speech parameters and VP function in appropriately selected cleft palate patients. However, VPCR alone is insufficient to fully predict resonance outcomes.
Keywords: Radical intravelar veloplasty (IVVP), Velopharyngeal (VP) insufficiency, Speech outcomes, Secondary palatoplasty, Hypernasality (HN)
Article type: Original Research Articles |
Subject:
Speech therapy
Received: 2025/12/16 | Accepted: 2026/05/2 | Published: 2026/09/26
Received: 2025/12/16 | Accepted: 2026/05/2 | Published: 2026/09/26
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