Patient and surgical factors that affect the development of velopharyngeal insufficiency

Velopharyngeal insufficiency (VPI) is a complication that occurs following cleft palate (CP) repair, and the patient/surgical factors that contribute to the development of VPI have not been completely described. The objectives of this study were to identify patient and surgical factors that may increase the risk of development of VPI and to identify whether there are any factors that predispose patients to the development of VPI that requires surgery versus VPI that resolves with non-operative management. Data was prospectively collected for all non-syndromic patients with a CP undergoing primary CP repair by a single surgeon between 2002 and 2018. Patient factors were recorded from patient charts, and anatomic measurements were recorded by the primary surgeon at the time of palate repair. The rates of VPI requiring surgery were compared between (1) patients with cleft lip/palate versus isolated CP, (2) patient gender, (3) unilateral or bilateral cleft, (4) complete or incomplete cleft, (5) the type of primary palatoplasty performed, and (6) the presence of palatal fistula. Data were analyzed retrospectively using a combination of Chi-square tests, t-tests, and one-way ANOVA. Overall, 229 patients were identified in this study, and the total rate of VPI was identified as 30.1%. The risk of VPI development was associated with bilateral cleft lip/palate (p = 0.01), increased pre-operative cleft width (p = 0.03), and von Langenbeck palatoplasty (p<0.01). No factors were found to be associated with operative versus non-operative VPI. Moving forward, at-risk patients should be identified early and monitored closely for the development of VPI.