Management of Acquired Velopharyngeal Insufficiency in Adults: A Systematic Review and Meta-Analysis

To evaluate treatment outcomes for non-cleft, acquired velopharyngeal insufficiency (VPI) in adults and synthesize the efficacy and safety of available interventions.

PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library were searched for studies published from January 2005 to October 2025.

Studies were included if they evaluated interventions with speech and/or swallow outcomes in adults (≥ 18 years) with VPI. Two reviewers independently screened studies, extracted data, and assessed quality. Random-effects meta-analysis using logit-transformed pooled proportions determined rates of speech and swallowing improvement.

Of 1167 records screened, 11 studies met inclusion criteria, representing 107 adults and 163 interventions. VPI most occurred after head and neck cancer treatment (45%) or neurologic disease (47%). 63.5% had small to moderate VPI. Injection pharyngoplasty (IP) was the most frequently used intervention (82.2%), followed by palatal lift prosthesis (7.4%) and surgical reconstruction (5.5%). Meta-analysis demonstrated improved speech and swallow in 88% (95% CI: 78%-94%) and 78% (95% CI: 49%-93%) across all interventions, and in 88% (95% CI: 73%-95%) and 71% (95% CI: 34%-92%) in IP patients, respectively. IP is effective and has a low 5.2% adverse events rate.

Acquired VPI in adults is highly treatable, with most patients experiencing improvement in speech and swallowing across interventions. However, evidence remains limited by small sample sizes and heterogeneous outcome reporting. Prospective and comparative studies using standardized diagnostic criteria and uniform outcome measures are required to better define optimal treatment selection for this adult population.

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