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Tue, May 26, 2026
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1- Ph.D. Assistant Professor in Speech Therapy, Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2- MSc in Speech Therapy, Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Ph.D. Student in Speech Therapy, Rehabilitation Research Center, Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
4- PhD, Department of Speech and Language Pathology, Saint Mary’s College, Notre Dame, Indiana, USA
5- MD. Ph.D. Plastic Surgeon, Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2- MSc in Speech Therapy, Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Ph.D. Student in Speech Therapy, Rehabilitation Research Center, Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
4- PhD, Department of Speech and Language Pathology, Saint Mary’s College, Notre Dame, Indiana, USA
5- MD. Ph.D. Plastic Surgeon, Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract: (57 Views)
Objectives:
Velopharyngeal insufficiency (VPI) is a persistent complication after primary palatoplasty that adversely affects speech. Radical intravelar veloplasty (IVVP) has been proposed as a secondary reconstructive technique aimed at restoring velopharyngeal function. This study aimed to evaluate speech outcomes and velopharyngeal closure following radical IVVP in non-syndromic cleft palate patients.
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 velopharyngeal 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), ANEs (p = 0.001, r = 0.33), and NOE (p<0.001, r=0.43). VPCR improved significantly (from 0.48 to 0.70, 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, OR = 0.20, 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
This study evaluated the outcomes of IVVP in non-syndromic cleft palate patients. It demonstrated significant improvements in speech characteristics, a reduction in fistula rate, and an increase in VPCR. Nevertheless, many patients retained residual HN or required subsequent surgical intervention, underscoring the complexity of speech management. Younger age at surgery and fewer preoperative non‑oral errors were associated with better outcomes, while VPCR improvement was associated with reduced HN severity, it did not consistently predict complete perceptual normalization. These findings emphasize the importance of early intervention and combined perceptual and instrumental assessment in postoperative management.
Conclusion
Radical IVVP achieves significant functional improvement across key speech parameters and velopharyngeal (VP) function in appropriately selected cleft palate patients. However, VPCR alone is insufficient to fully predict resonance outcomes.
Velopharyngeal insufficiency (VPI) is a persistent complication after primary palatoplasty that adversely affects speech. Radical intravelar veloplasty (IVVP) has been proposed as a secondary reconstructive technique aimed at restoring velopharyngeal function. This study aimed to evaluate speech outcomes and velopharyngeal closure following radical IVVP in non-syndromic cleft palate patients.
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 velopharyngeal 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), ANEs (p = 0.001, r = 0.33), and NOE (p<0.001, r=0.43). VPCR improved significantly (from 0.48 to 0.70, 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, OR = 0.20, 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
This study evaluated the outcomes of IVVP in non-syndromic cleft palate patients. It demonstrated significant improvements in speech characteristics, a reduction in fistula rate, and an increase in VPCR. Nevertheless, many patients retained residual HN or required subsequent surgical intervention, underscoring the complexity of speech management. Younger age at surgery and fewer preoperative non‑oral errors were associated with better outcomes, while VPCR improvement was associated with reduced HN severity, it did not consistently predict complete perceptual normalization. These findings emphasize the importance of early intervention and combined perceptual and instrumental assessment in postoperative management.
Conclusion
Radical IVVP achieves significant functional improvement across key speech parameters and velopharyngeal (VP) function in appropriately selected cleft palate patients. However, VPCR alone is insufficient to fully predict resonance outcomes.
Keywords: Radical Intravelar Veloplasty, Velopharyngeal insufficiency, Speech outcomes, Secondary palatoplasty, Hypernasality
Article type: Original Research Articles |
Subject:
Speech therapy
Received: 2025/12/16 | Accepted: 2026/05/2
Received: 2025/12/16 | Accepted: 2026/05/2
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