# Longitudinal Speech Changes in Velopharyngeal Function in Submucous Cleft Palate

## TL;DR

This study shows that children with submucous cleft palate and velopharyngeal dysfunction can improve speech over time, but surgery is needed for significant progress during early development.

## Contribution

The study provides longitudinal evidence on the effectiveness of surgical versus nonsurgical treatment for speech improvement in submucous cleft palate.

## Key findings

- Surgical patients showed slower speech score improvement post-surgery compared to pre-surgery rates.
- Nonsurgical patients improved speech scores over time, but not within the critical speech development window.
- Without surgery, it would take about 9 years to reach normal speech scores from a median presurgical score of 14.

## Abstract

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

Retrospective cohort study.

Single academic medical center.

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.

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).

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.