Preoperative velopharyngeal morphology in older cleft palate patients with postoperative velopharyngeal closure versus velopharyngeal insufficiency.

The purpose of this study was to investigate the preoperative morphology of velopharyngeal structures in older patients with cleft palate and to evaluate which structure(s) could distinguish velopharyngeal function. The investigators implemented a retrospective study and 66 patients whose palate was repaired by 1 surgeon with the same technique were selected, including 38 boys and 28 girls, aged from 5 years and 1 month to 28 years and 6 months. All these patients were taken lateral preoperative cephalograms at rest and during phonation of /i/. Fifteen lengths, 3 ratios, and 1 angle variable were defined in this study. The follow-up time was from 3 months to 12 months. All these measurements were analyzed by independent samples t test and discriminant analysis in a stepwise method, while P value was set at 0.05. In this study, there were 30 patients with velopharyngeal closure (VPC) and 36 patients with velopharyngeal insufficiency (VPI) after surgery. Differences in velar length, posterior velar length, pharyngeal height, hard-soft palatal angle, and pharyngeal height-depth ratio were significantly different at rest, while all the measurements during phonation were not significantly different. Discriminant analysis showed that the VPC group could be discriminated from the VPI group primarily on the basis of velar length, pharyngeal depth, and VP ratio, of which the correlation ratio was 0.963 and the discriminant rate was 100%. Therefore, the results suggested not only velar length and pharyngeal depth but also pharyngeal height significantly affected the formation of normal velopharyngeal function. Furthermore, there was a strong prognostic significance of preoperative velar length, pharyngeal depth, and VP ratio for postoperative velopharyngeal function.