en گفتار درمانی Speech therapy پژوهشي Original Research Articles <strong>Objectives</strong>: 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.<br> <strong>Methods</strong>: 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).<br> <strong>Results</strong>: 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 (&beta;=&minus;1.59, odds ratio [OR]=0.2, P=0.02), age at surgery (&beta;=0.08, OR=1.08, P=0.04), and postoperative VPCR (&beta;=&minus;0.29, OR=0.75, P=0.05) were statistically significant predictors of the outcome (All P&le;0.05).<br> <strong>Discussion</strong>: 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. Radical intravelar veloplasty (IVVP), Velopharyngeal (VP) insufficiency, Speech outcomes, Secondary palatoplasty, Hypernasality (HN) 321 332 http://irj.uswr.ac.ir/browse.php?a_code=A-10-2614-2&slc_lang=en&sid=1 Mehri Tavakoli tavakkoli.mehri@ymail.com 0009-0009-8648-1637 No Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Parisa Rezaei parisa.re.8946@gmail.com 0000-0002-2430-8822 No Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Neda Tahmasebifard ntahmasebifard@saintmarys.edu 0009-0003-6109-2009 No Saint Mary’s College, Notre Dame, United States of America. Hossein Abdali abdali@med.mui.ac.ir 0000-0003-1421-4504 No Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Fatemeh Derakhshandeh derakhshandeh@rehab.mui.ac.ir 0000-0003-0261-050X Yes Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.