Longitudinal Speech Changes in Velopharyngeal Function in Submucous Cleft Palate.

Objective: To evaluate longitudinal speech changes in surgical and nonsurgical patients with submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD).

Study design: Retrospective cohort study.

Setting: Single academic medical center.

Methods: In total, 204 patients with documented SMCP and VPD from January 2002 to 2008 were identified. Using a multilevel mixed-effects model, we examined the association between surgical status and speech score trajectories, adjusting for age, sex, race, and severity.

Results: In total, 204 children were included (mean [SD] age, 4.9 [3.1] years; 124 [60.8%] male; 114 [55.9%] furlow palatoplasty). Amongst surgical patients, the postsurgical median baseline score was 4 and scores were predicted to continue to decrease over time at a rate of 0.04 points per year (coefficient [β] -0.04, 95% confidence interval [95% CI] -0.20 to 0.13, P = .64). Presurgical speech scores were predicted to decrease over time at a rate of 0.78 points per year (β -0.78, 95% CI -1.14 to -0.41, P < .001). With a median presurgical score of 14, it would take 9 years to achieve normal speech scores without surgical intervention. In nonsurgical patients, speech scores were predicted to decrease at a rate of 0.23 points per year (β -0.23, 95% CI -0.51 to 0.04, P = .094).

Conclusion: Speech production in VPD can improve over time without surgical intervention but is not expected to do so within the critical window for speech development. Surgical intervention improves speech by rates of change that cannot be achieved without surgery.