Perceptual Speech Outcomes and Videofluoroscopic Findings After Radical Intravelar Veloplasty

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 ۹۴ 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 ۵۳ 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<۰.۰۵). Results: Postoperative assessments at a minimum of ۶ months (median follow-up: ۱۵ months) demonstrated significant reductions in HN (P<۰.۰۰۱, r=۰.۶۵), ANE (P=۰.۰۰۱, r=۰.۳۳), and NOE (P<۰.۰۰۱, r=۰.۴۳). VPCR improved significantly (from ۰.۴۸ to ۰.۷, P<۰.۰۰۱, r=۰.۰۷), and complete closure was achieved in ۱۳ patients. The fistula rate decreased significantly from ۲۱.۲% to ۷.۴% (P=۰.۰۰۲). The ordinal logistic regression model indicated that Preoperative NOEs (β=−۱.۵۹, odds ratio [OR]=۰.۲, P=۰.۰۲), age at surgery (β=۰.۰۸, OR=۱.۰۸, P=۰.۰۴), and postoperative VPCR (β=−۰.۲۹, OR=۰.۷۵, P=۰.۰۵) were statistically significant predictors of the outcome (All P≤۰.۰۵). 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.

کلیدواژه ها:

Radical intravelar veloplasty (IVVP) ، Velopharyngeal (VP) insufficiency ، Speech outcomes ، Secondary palatoplasty ، Hypernasality (HN)