Speech Outcomes After Primary Palatoplasty With Intravelar Veloplasty and Extensive Muscle Dissection: A Single-Surgeon Cohort Study

This retrospective single-surgeon cohort study evaluated speech outcomes in 79 children with nonsyndromic cleft palate, with or without cleft lip, who underwent primary palatoplasty with intravelar veloplasty involving extensive palatal muscle dissection, performed by a single surgeon between 2015 and 2023. Hypernasality and velopharyngeal competence were assessed through auditory-perceptual evaluation using a 4-point ordinal scale and the Velopharyngeal Competence Rating (VPC-R). The mean age at surgery was 1 year and 10 months, and the mean age at speech recording was 4 years and 9 months. Absence of hypernasality was observed in 85% of participants, whereas 6% presented mild and 9% moderate hypernasality; no cases of severe hypernasality were identified. Adequate velopharyngeal competence was observed in 72% of participants, marginal competence in 19%, and velopharyngeal incompetence in 9%. All cases classified as moderately hypernasal corresponded to velopharyngeal incompetence. These findings indicate that primary palatoplasty incorporating extensive intravelar muscle dissection was associated with favorable perceptual speech outcomes in this single-surgeon cohort.