The Rise in Artificial Intelligence and Machine Learning Models to Screen for Cleft-Related Velopharyngeal Dysfunction: A Systematic Review

ObjectiveTo systematically review literature on the use of artificial intelligence (AI) and machine learning (ML) models for detecting velopharyngeal dysfunction (VPD) in patients with cleft palate.DesignSystematic review conducted in accordance with PRISMA guidelines (PROSPERO CRD420251034524).SettingStudies published were identified through EMBASE, ProQuest, Google Scholar, and PubMed.ParticipantsA total of 3967 participants contributed 92,323 training samples. Internal validation included 2331 controls and 2449 VPD cases, generating 81,143 validation samples. Ages ranged from 1 to 93 years.InterventionsML models were trained on speech features such as mel frequency cepstral coefficients (MFCCs) and constant Q cepstral coefficients (CQCCs) to classify or validate VPD-related speech outcomes.Main Outcome Measure(s)Reported performance metrics included accuracy, precision, recall, F1-score, sensitivity, specificity, and Pearson correlation coefficient (PCC). External validation was assessed when reported.ResultsOf 455 screened articles, 34 met the inclusion criteria. Support vector machines were the most commonly used models (16/34, 47.1%), followed by convolutional neural networks (6/34, 17.6%) and deep neural networks (2/34, 5.9%). Across studies reporting performance metrics, midpoint estimates yielded a mean accuracy of 82.9%, precision of 86.7%, F1-score of 0.88, sensitivity of 80.5%, specificity of 82.2%, and PCC of 0.58. Only 3 studies (3/34, 8.8%) performed external validation.ConclusionsAI/ML models demonstrate promise for VPD detection with encouraging performance. Inconsistent reporting, reliance on engineered features, and limited external validation restrict generalizability. No clinically deployable model has yet been achieved.