Long-term stability of postpalatoplasty perceptual speech ratings: A prospective study

This prospective study was undertaken to assess the long-term stability of velopharyngeal perceptual speech ratings of patients with repaired cleft pa late. All patients were evaluated and managed at the Cleft Palate and Crani ofacial Deformities institute, St. Louis Children's Hospital. Patients alte rnately received palatoplasty with or without intravelar veloplasty. Two se nior surgeons standardized their operative procedures and performed or supe rvised directly all operations. Perceptual speech and language evaluations were conducted by the same experienced speech pathologist when the children were 6 years old and 12 years or older. Data were analyzed from the 28 pat ients available for long-term follow-up. The intravelar veloplasty (N = 14) and nonintravelar veloplasty (N = 14) groups were similar with respect to cleft anatomy and mean age at palatoplasty and at the second perceptual spe ech evaluation. Evaluation of the 12-year-old and older ratings indicated t hat the overwhelming majority of patients improved or maintained clinical s tability in perceptual ratings of velopharyngeal function. When assessing d irection and magnitude of change (i.e., incremental improvement vs. deterio ration), the intravelar veloplasty and nonintravelar veloplasty groups had a similar distribution of perceptual speech ratings at both the 6-year and 12-year or older speech evaluations. Results were consistent with previousl y published data from our center, that the intravelar veloplasty procedure did not affect demonstrably the incidence of postpalatoplasty auditory perc eptual symptoms of velopharyngeal dysfunction.