Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in pre-school children with UCLP operated with early or delayed hard palate repair.
Design: subgroup analysis within a multicentre RCT of primary surgery (Scandcleft).
Setting: Tertiary healthcare. One surgical centre.
Subjects and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3-4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size in relation to palatal size and cleft morphology were measured three-dimensionally on digital models, obtained by laser surface scanning of pre-operative plaster models (mean age 1.8 months).
Main outcome measurements: velopharyngeal competence and hypernasality assessed from a naming test (VPC-Sum, composite score) and connected speech (VPC-Rate). In both scales higher scores indicated a more severe velopharyngeal insufficiency.
Results: a low positive correlation was found between posterior cleft width and VPC-Rate (Spearman= .23; P=.025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (OR=1.17; 95CI:1.01;1.35). A low negative correlation was shown between antero-posterior palatal length and VPC-Sum (Spearman= -.27; P=.004) and confirmed by the pooled scores VPC-Pooled (OR=.82; 95CI: .69;.98) and VPC-dichotomic (OR=.82; 95CI: .68;.99).
Conclusions: posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 year, in a two-stage surgical protocol where soft palate is closed first, independently on timing of hard palate repair. Antero-posterior palatal length seems to protect from VPI and hypernasality. However, the association found was significant but low.