Long-Term Speech Outcomes After Primary Palatoplasty: A Comparison of Minimal-Incision Intravelar and Modified Veau-Wardill-Kilner Techniques.

Background/Objectives: Speech outcome is a major functional endpoint following primary palatoplasty. This study compared long-term speech outcomes after closed intravelar minimal-incision palatoplasty and the modified Veau-Wardill-Kilner procedure. Methods: This retrospective observational study evaluated speech using a standardized perceptual protocol adapted to the Bulgarian phonetic system across eight domains. Outcomes were compared between surgical groups, with additional analyses stratified by age and cleft type. Results: The minimal-incision group showed higher unadjusted proportions of normal speech intelligibility (29.4% vs. 17.6%, p = 0.020), normal resonance (73.2% vs. 54.9%, p = 0.001), and normal consonant articulation (37.8% vs. 19.0%, p < 0.001), whereas compensatory articulation was less frequent (49.6% vs. 65.5%, p = 0.008). Hypernasality, voice quality, and vowel articulation were comparable between groups. After adjustment for cleft type and age group, no significant association was observed between surgical technique and normal speech intelligibility (aOR 1.33, 95% CI 0.73-2.43; p = 0.357), whereas the minimal-incision technique was associated with higher odds of normal consonant articulation (aOR 1.79, 95% CI 1.01-3.18; p = 0.047) and normal resonance (aOR 1.73, 95% CI 1.02-2.94; p = 0.043). Conclusions: Both techniques were associated with broadly comparable long-term functional speech outcomes across most evaluated domains. After adjustment for cleft type and age group, differences remained in normal consonant articulation and normal resonance, whereas no significant adjusted association was observed for normal speech intelligibility. These findings should be interpreted cautiously given the historical treatment patterns, non-random distribution of cleft type between groups, and potential residual confounding.