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Patient Factors Influencing Speech Outcomes in Velopharyngeal Function Following Initial Cleft Palate Repair: A Systematic Review and Meta-Analysis

Lookup NU author(s): David Sainsbury, Peter Hodgkinson


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© 2023, American Cleft Palate Craniofacial Association. Objective: Identification of patient factors influencing velopharyngeal function for speech following initial cleft palate repair. Design: A literature search of relevant databases from inception until 2018 was performed using medical subject headings and keywords related to cleft palate, palatoplasty and speech assessment. Following three stage screening data extraction was performed. Setting: Systematic review and meta-analysis of relevant literature. Patients/Participants: Three hundred and eighty-three studies met the inclusion criteria, comprising data on 47 658 participants. Interventions: Individuals undergoing initial palatoplasty. Main Outcome Measures: Studies including participants undergoing initial cleft palate repair where the frequency of secondary speech surgery and/or velopharyngeal function for speech was recorded. Results: Patient factors reported included cleft phenotype (95% studies), biological sex (64%), syndrome diagnosis (44%), hearing loss (28%), developmental delay (16%), Robin Sequence (16%) and 22q11.2 microdeletion syndrome (11%). Meta-analysis provided strong evidence that rates of secondary surgery and velopharyngeal dysfunction varied according to cleft phenotype (Veau I best outcomes, Veau IV worst outcomes), Robin Sequence and syndrome diagnosis. There was no evidence that biological sex was associated with worse outcomes. Many studies were poor quality with minimal follow-up. Conclusions: Meta-analysis demonstrated the association of certain patient factors with speech outcome, however the quality of the evidence was low. Uniform, prospective, multi-centre documentation of preoperative characteristics and speech outcomes is required to characterise risk factors for post-palatoplasty velopharyngeal insufficiency for speech. Systematic Review Registration: Registered with PROSPERO CRD42017051624.

Publication metadata

Author(s): Sainsbury DCG, Williams CC, Butterworth S, de Blacam C, Fell MJ, Mullen J, Breakey W, Murphy C, Hodgkinson PD, Wren Y

Publication type: Article

Publication status: Published

Journal: Cleft Palate Craniofacial Journal

Year: 2023

Pages: Epub ahead of print

Online publication date: 02/08/2023

Acceptance date: 02/04/2018

ISSN (print): 1055-6656

ISSN (electronic): 1545-1569

Publisher: SAGE Publications Ltd


DOI: 10.1177/10556656231191384

PubMed id: 37533341


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Funder referenceFunder name
Craniofacial Society of Great Britain and Ireland