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Background <p>Residual velopharyngeal insufficiency (VPI) after primary cleft palate repair continues to impair speech, psychosocial functioning, and overall quality of life (QOL). Although VPI surgery is a standard intervention, further evidence is needed regarding its impact on patient-reported outcomes (PROMs) and the clinical factors associated with postoperative quality-of-life improvement. This study evaluated changes in VPI-related QOL before and after secondary VPI surgery using the validated Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument, contextualized these findings using a reference group with velopharyngeal competence (VPC), and identified key clinical determinants of postoperative QOL.</p> Methods <p>A retrospective study was conducted on 170 participants, including 85 patients with residual VPI undergoing secondary palatoplasty and 85 participants with established VPC. Certified cleft specialists assessed speech and functional outcomes, while QOL was measured using the validated Chinese version of the VELO instrument. Postoperative speech and VELO assessments were conducted at a mean follow-up of 5.7 ± 4.0 years after surgery. Statistical analyses included Chi-square, Wilcoxon rank, and Mann–Whitney U tests; multivariate logistic regression identified predictors of inadequate postoperative QOL.</p> Results <p>At baseline, VPI patients demonstrated significantly poorer speech performance, higher oronasal fistula (ONF) rates, and lower VELO scores than the reference group (all <i>P</i> &lt; 0.001). Following surgery, ONF rates declined from 27.1% to 5.9%, 63.5% achieved normal speech, and 71.8% attained competent velopharyngeal closure (<i>P</i> &lt; 0.001). VELO total scores improved markedly from 53.4 ± 15.7 to 87.3 ± 9.0, showing substantial improvement and moving closer to the range observed in the reference group (91.4 ± 7.2). Domain-level analyses revealed broad functional and psychosocial recovery, particularly in situational and emotional impact domains. Speech intelligibility deficiency and ONF were significantly associated with poor postoperative QOL, while residual VPI showed a weaker association.</p> Conclusions <p>Secondary VPI surgery yields substantial improvements in both functional and patient-reported outcomes. Marked gains in postoperative VELO scores highlight the procedure’s role in improving VPI-related quality of life and psychosocial functioning. Speech intelligibility deficiency and ONF status were the strongest factors associated with postoperative QOL, highlighting the importance of optimizing functional speech outcomes and integrating PROM-informed cleft care.</p>

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Restoration of quality of life following secondary velopharyngeal insufficiency surgery: a VELO-informed study with reference to velopharyngeal competence

  • 期刊论文

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  • 发表日期：

    2026年7月30日

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  • Karim Ahmed Sakran,
  • Qihang Chen,
  • Zongsheng Xu,
  • Remsh Khaled Al-Rokhami,
  • Hanyao Huang,
  • Bing Shi,
  • Xiaobao Dang

摘要

Background

Residual velopharyngeal insufficiency (VPI) after primary cleft palate repair continues to impair speech, psychosocial functioning, and overall quality of life (QOL). Although VPI surgery is a standard intervention, further evidence is needed regarding its impact on patient-reported outcomes (PROMs) and the clinical factors associated with postoperative quality-of-life improvement. This study evaluated changes in VPI-related QOL before and after secondary VPI surgery using the validated Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument, contextualized these findings using a reference group with velopharyngeal competence (VPC), and identified key clinical determinants of postoperative QOL.

Methods

A retrospective study was conducted on 170 participants, including 85 patients with residual VPI undergoing secondary palatoplasty and 85 participants with established VPC. Certified cleft specialists assessed speech and functional outcomes, while QOL was measured using the validated Chinese version of the VELO instrument. Postoperative speech and VELO assessments were conducted at a mean follow-up of 5.7 ± 4.0 years after surgery. Statistical analyses included Chi-square, Wilcoxon rank, and Mann–Whitney U tests; multivariate logistic regression identified predictors of inadequate postoperative QOL.

Results

At baseline, VPI patients demonstrated significantly poorer speech performance, higher oronasal fistula (ONF) rates, and lower VELO scores than the reference group (all P < 0.001). Following surgery, ONF rates declined from 27.1% to 5.9%, 63.5% achieved normal speech, and 71.8% attained competent velopharyngeal closure (P < 0.001). VELO total scores improved markedly from 53.4 ± 15.7 to 87.3 ± 9.0, showing substantial improvement and moving closer to the range observed in the reference group (91.4 ± 7.2). Domain-level analyses revealed broad functional and psychosocial recovery, particularly in situational and emotional impact domains. Speech intelligibility deficiency and ONF were significantly associated with poor postoperative QOL, while residual VPI showed a weaker association.

Conclusions

Secondary VPI surgery yields substantial improvements in both functional and patient-reported outcomes. Marked gains in postoperative VELO scores highlight the procedure’s role in improving VPI-related quality of life and psychosocial functioning. Speech intelligibility deficiency and ONF status were the strongest factors associated with postoperative QOL, highlighting the importance of optimizing functional speech outcomes and integrating PROM-informed cleft care.