Long-Term Velopharyngeal Insufficiency–Related Quality of Life in Cleft Palate Patients: Speech and Surgical Factors

INTRODUCTION AND AIMS: Velopharyngeal insufficiency (VPI) is a common functional complication in patients with cleft palate, often resulting in impaired speech, social difficulty, and psychosocial distress. This study aims to assess VPI-related quality of life (VPI-QOL) in cleft palate patients after primary palatoplasty, and to identify clinical and functional predictors, particularly speech outcomes and postoperative complications, that significantly affect the perceived QOL. METHODS: This cross-sectional study involved 170 cleft palate patients assessed using the validated Chinese version of the VPI Effects on Life Outcomes (VELO) instrument. Both parent-proxy and youth self-reports were collected. Patients were stratified by QOL status into adequate and inadequate QOL groups. Demographic, surgical, and anatomical variables, along with professional speech evaluations, were analysed. Statistical comparisons used Chi-square and Mann-Whitney U tests, with multivariate logistic regression to identify independent predictors of poor QOL. RESULTS: Among 170 patients, 107 (62.9%) had adequate and 63 (37.1%) had inadequate QOL. Inadequate QOL was associated with older age at surgery (mean 5.19 vs 1.98 years; P < .001) and at evaluation (P < .01). Oronasal fistula (ONF) occurred in 14.7%, and VPI in 30%. Delayed palatoplasty, presence of ONF, and poor speech intelligibility were significantly linked to lower VELO scores. ONF (odds ratio = 8.531, P < .001) and speech intelligibility deficits (odds ratio = 8.854, P < .001) were independent predictors of poor QOL. Patients with VPI reported significantly lower scores across all VELO domains. Youth and parental responses were generally consistent, with parents noting more pronounced emotional and social effects. CONCLUSION: Speech deficits and postoperative complications, particularly ONF and reduced intelligibility, are major determinants of VPI-related QOL. Timely surgery, prevention of ONF, and targeted speech intervention are essential for optimizing both functional and psychosocial outcomes. CLINICAL RELEVANCE: Speech intelligibility and ONF strongly influence VPI-QOL; early surgery, ONF management, speech therapy, and VELO use improve outcomes and guide multidisciplinary cleft care.