Which intraoral parameters are prognostic factors for speech outcomes in incomplete cleft palate?

Vollständiger Abstract

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Background: The goal of cleft palate surgery is to improve speech articulation; however, factors predicting postoperative speech outcome remain unclear. This study aimed to identify anatomical parameters associated with speech outcome in patients with incomplete cleft palate.Methods: Ninety-eight patients with incomplete cleft palate who underwent palatoplasty and completed long-term follow-up of more than 4 years were included. All surgeries were performed by a single senior surgeon, and eight intraoral parameters were consistently measured intraoperatively. Speech outcomes were evaluated at 4 years of age using the Pittsburgh Weighted Speech Scale (PWSS) and the Simple Speech Screening Protocol (SSSP). Pearson correlation analysis, Kruskal–Wallis test, and multivariable linear regression analyses were performed to assess associations between anatomical parameters and speech outcomes.Results: Most parameters showed no significant correlation with PWSS or SSSP. However, a greater preoperative straight palatal length and a greater postoperative curved palatal length were significantly associated with lower PWSS scores (p< 0.05). In multivariable analysis, postoperative curved palatal length remained independently associated with PWSS, and palatal width also showed a significant association, with wider palate associated with poorer speech outcome (p< 0.05).Conclusion: Most intraoral anatomical parameters were not independently associated with speech outcome, suggesting that factors beyond simple anatomical measurements—particularly those related to restoring appropriate velopharyngeal function, such as reconstruction of the levator veli palatini muscle—may play a more important role. Nevertheless, preoperative straight palatal length, postoperative curved palatal length, and palatal width demonstrated meaningful associations with speech outcome. Therefore, these parameters should be considered when planning palatoplasty to optimize postoperative speech outcome.