Multidimensional factors in submucous cleft palate velopharyngeal function: a large cohort study.

This retrospective study analyzed clinical characteristics and surgical outcome predictors in 676 patients with submucous cleft palate (SMCP) treated between 2008 and 2025. Patients were stratified by palatal morphology to evaluate velopharyngeal function and articulation. Among 183 patients surgically treated for velopharyngeal insufficiency (VPI), postoperative cure rates were assessed using regression analysis. Preoperatively, 52.96% of the cohort presented with VPI. Palatal morphology significantly correlated with function; the bifid uvula subtype exhibited the highest rate of velopharyngeal competence (49.60%), while the palatal fistula subtype had the lowest (16.67%). Crucially, analysis of surgical outcomes identified younger age as the sole significant predictor of achieving competence (median age 5.83 years for cured versus 10.00 for non-cured patients; P = 0.002). The odds of an unfavorable outcome increased by approximately 9% for each additional year of age. While specific morphologies, such as the translucent zone with bifid uvula, and severe hypernasality impacted prognosis, surgical timing proved paramount. These findings emphasize that while morphology and articulation status aid initial assessment, early diagnosis and timely intervention are the most critical factors for optimizing speech outcomes in SMCP patients.