Intravelar veloplasty with posterior pillar flap for velopharyngeal insufficiency correction in cleft palate patients: A prospective trial

Introduction: Cleft palate is a very common congenital defect that disrupts velopharyngeal closure leading to some complications such as velopharyngeal insufficiency (VPI) and hypernasality. After initial surgical repair, about 20%–30% continue to have persistent VPI requiring additional surgical procedures. This study evaluates the outcome of intravelar veloplasty in conjunction with the posterior tonsillar pillar flap to elongate the palate, improve the competence of the velopharynx, and reduce hypernasality. Materials and Methods: This was a prospective clinical trial conducted from 2018 to 2019 at Al-Zahra Hospital, Isfahan, Iran. A total of 40 patients with persistent VPI following cleft palate repair underwent intravelar veloplasty for the reconstruction of the levator veli palatini muscle sling under general anesthesia. This procedure was then followed by posterior pillar flap mobilization for palatal lengthening. In this study, preoperative and postoperative outcomes were assessed regarding velopharyngeal adequacy by measuring gap and assessing speech through satisfaction scores using videofluoroscopy. Results: At 1-year follow-up, 62.5% of patients showed adequate velopharyngeal closure, with significant gap measures improvement, as evidenced by P < 0.001. Younger age groups (<10 years) had better results than the older ones with P = 0.019. The satisfaction score ranked highest in patients at 7.2 ± 0.82, followed by expert panels at 6.33 ± 0.8, then surgeons at 6.55 ± 0.93. There were no significant differences according to gender or cleft type. Conclusion: The combined intravelar veloplasty and posterior pillar flap technique considerably improves the palatal length, velopharyngeal closure, and hypernasality in patients with persistent VPI, particularly in carefully selected cases. Larger studies with longer follow-up are needed to confirm these findings and overcome study limitations.