Xiao Luo, Pinting He, Min Wu, Heng Yin, Jordan P Steinberg, Xu Cheng, Qian Zheng, Bing Shi, Chenghao Li
Patients with cleft palate exhibited long‑term instability in VPF following primary palatoplasty. Velar elevation angle was associated with VPF improvement, while older age at repair and lower velopharyngeal ratio were associated with deterioration.
OBJECTIVES: This study aimed to delineate the longitudinal trajectory of velopharyngeal function (VPF) following primary cleft palate repair and characterize potential associated parameters to inform early treatment planning.
MATERIALS AND METHODS: This retrospective study analyzed 313 consecutive patients who underwent primary cleft palate repair before age 5, with minimum 3‑year follow‑up and three postoperative timepoints. Patients with a history of professional speech therapy were excluded to observe the natural history of VPF. Data from medical records, perceptual speech evaluations, and imaging assessments were analyzed. A generalized additive model assessed the association between first follow‑up interval and VPF consistency. Multivariable logistic regression identified independent factors associated with VPF improvement and deterioration.
RESULTS: Stable VPF across all follow‑ups was observed in 75.72% (237/313) of patients, while approximately one-quarter of patients (24.28%) demonstrated changes in VPF during longitudinal follow-up after primary palatoplasty. Longer first follow‑up interval was associated with higher consistency, with predicted probabilities of 80% at 2.16 years and 95% at 3.66 years post‑surgery. Patients with VPF changes underwent repair significantly later than stable patients (P = 0.001). Velar elevation angle was independently associated with VPF improvement (P < 0.001). Older age at repair (P = 0.033) and lower velopharyngeal ratio (P = 0.008) were independently associated with VPF deterioration.
CONCLUSIONS: Patients with cleft palate exhibited long‑term instability in VPF following primary palatoplasty. Velar elevation angle was associated with VPF improvement, while older age at repair and lower velopharyngeal ratio were associated with deterioration.
CLINICAL RELEVANCE: These findings provide preliminary evidence to support a risk-stratified follow-up strategy. However, the proposed framework is hypothesis-generating and requires external validation in prospective cohorts before clinical implementation.