Perceptual Assessment Of Velo Pharyngeal Insufficiency After SuperiorBased Pharyngeal Flap: Non Randomized Control Trial

Objective: To evaluate the speech outcomes following superiorly based pharyngeal flap surgery in non-syndromic cleft lip and palate patients using perceptual speech assessment.Methods: This study was conducted on 22 patients operated between 1st January 2022 and 31st December 2022 by a senior surgeon. The sample included 14 males and 8 females aged 9–27 years. Patients with repaired cleft lip and palate diagnosed with VPI by speech-language pathologists were included. Patients with syndromes, hearing impairment, submucous cleft palate or who developed any postoperative complications were excluded from the study. The assessment of speech was performedby two speech-language pathologists one week preoperatively and 12 months postoperatively. Preoperative pharyngoscopy was also carried out by an ENT surgeon to assess the gap between the velum and posterior pharyngeal wall.Results: Among 22 patients, hypernasality was absent in 2, mild in 6, moderate in 10, and severe in 4 patients preoperatively. Following surgery, the severity of hypernasality markedly improved, with postoperative assessment demonstrating absent hypernasality in 2 patients, mild in 5, moderate in 1, and no patients exhibiting severe hypernasality. These findings indicate a substantial postoperative reduction in the severity of hypernasality among the majority of patients. Similarly, speech turbulence was graded as mild in 3 patients, moderate in 8, and severe in 11 patients preoperatively. While, postoperative evaluation showed that there was considerable improvement, with turbulence reducing to mild in 13 patients, moderate in 7, and severe in only 2 patients. Overall, the surgical intervention resulted in significant improvement in speech quality and reduction in turbulence in most patients.Out of the 22 patients, 20 demonstrated noticeable improvement in speech following the procedure.Conclusion:The superior based pharyngeal flap which is tailored to each patient helps to improve velopharyngeal insufficiency and hence speech in patients affected with cleft lip and palate.