Characterizing age at velopharyngeal dysfunction in patients with cleft palates

Background: Rates of velopharyngeal dysfunction (VPD) after palatoplasty are classically reported between the ages of 3 and 6 years. Here, we examined the continued risk of VPD in patients with cleft palates beyond age 6 years in our 40-year institutional cohort. Methods: We included patients with cleft palate and VPD who underwent follow-up in our team clinic from 1997 to 2017 and were at least 13 years old. We collected Veau class, dates of team visits, and dates of surgical interventions for VPD. Survival analysis was used to examine the age at which VPD was treated, the age differences between repair types, and the age differences between the first (1980–2001) and second (2001–2022) halves of the repair period. Results: Ninety-four patients received surgical interventions for VPD. The median age at VPD repair was 6.1 years. Repairs occurring after age 6 years totaled 51% (48/94). Secondary repair type was associated with age at VPD procedure (p < 0.01) with a median age at palatal re-repair of 12.1 years, compared to a median age of pharyngeal flap or sphincter pharyngoplasty of 4.8 and 5.2 years, respectively. Relative proportions of each repair type differed between the first and second halves of the study period (p < 0.01), with a significant reduction in sphincter pharyngoplasty (82%−18%, p < 0.01), and a significant increase in palatal re-repair (0%−71%, p < 0.01). Conclusions: A significant proportion of patients with cleft palates required secondary palatoplasty for VPD at ages >6 years. These findings highlight the importance of interval perceptual speech evaluations through adolescence to promote optimal velopharyngeal outcomes.