Velopharyngeal Competence in Children With Cleft Palate: Related Factors and Longitudinal Development

ObjectiveTo identify factors associated with velopharyngeal competence at 10 years of age in children with cleft palate, and examine the longitudinal development of velopharyngeal competence.DesignRegistry-based cohort study.SettingRegional public care university hospitals in Sweden.ParticipantsA total of 507 children born with a cleft palate with or without cleft lip/alveolus.Main Outcome MeasuresVelopharyngeal competence according to speech language pathologists' ratings corresponding to the VPC-Rate with and without consideration of intervening secondary speech-improving surgery.ResultsChildren with additional conditions had significantly lower odds of velopharyngeal competence with no intervening speech-improving surgery than those without (OR 0.60, 95% CI 0.37-0.99). Children who had primary palatal surgery after 25 months of age (OR 0.23, 95% CI 0.11-0.49) or in more than 1 stage (OR 0.49, 95% CI 0.31-0.78), also had lower odds of a positive outcome, but these results may have been impacted by differences in cleft subtypes. Prevalence of velopharyngeal competence regardless of intervening surgery was 85% at age 5 years and 93% at age 10 years. For 17 children, velopharyngeal dysfunction emerged after 5 years of age.ConclusionsAdditional conditions were associated with decreased odds of velopharyngeal competence with no intervening surgery at 10 years of age. Whether primary palatal surgery performed late and in multiple stages also decreases odds of velopharyngeal competence should be investigated further. Prevalence of velopharyngeal competence increased from 5 to 10 years of age. Speech follow-up in children with cleft palate should continue until at least 10 years of age.