This report highlights the long-term management of velopharyngeal insufficiency (VPI) and misarticulation in an 18-year-old male with unilateral cleft lip and palate. Despite primary and secondary surgeries, persistent VPI required a speech appliance and intensive therapy to address glottal stops and pharyngeal fricatives. While therapy eliminated these errors, residual VPI continued to impact speech intelligibility. Reassessment revealed that while some misarticulations persisted, the patient retained speech improvements from prior therapy, allowing for partial substitutions of target sounds. This case emphasizes the role of speech therapy in managing misarticulation despite unresolved VPI and highlights the need for ongoing multidisciplinary care.
DixonMJMarazitaMLBeatyTHMurrayJC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167-178. doi:https://doi.org/10.1038/nrg2933
2.
BrittonLAlberyLBowdenMHarding-BellAPhippenGSellD. A cross-sectional cohort study of speech in five-year-olds with cleft palate ± lip to support development of national audit standards: benchmarking speech standards in the United Kingdom. Cleft Palate Craniofac J. 2014;51(4):431-451. doi:https://doi.org/10.1597/13-121
3.
PerssonCPedersenN-HHaydenCBowdenMAuknerRVindenes H-AÅbyholmFWithbyDWilladsenELohmanderA. Scandcleft project trial 3: comparison of speech outcomes in relation to sequence in 2-stage palatal repair procedures in 5-year-olds with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2020;57(3):352-363. doi:https://doi.org/10.1177/1055665619896637
4.
SalesPCostaFCetira FilhoESilvaPAlbuquerqueALeãoJ. Effect of maxillary advancement on speech and velopharyngeal function of patients with cleft palate: systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2021;50(1):64-74. doi:https://doi.org/10.1016/j.ijom.2020.07.030
5.
BellRCowanKMarstonAP. Metanalysis of alloplastic materials versus autologous fat for injection augmentation pharyngoplasty treatment of velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol. 2021;146:110738. doi:https://doi.org/10.1016/j.ijporl.2021.110738
6.
PaniaguaLMSignoriniAVda CostaSSCollaresMVMDornellesS. Velopharyngeal dysfunction: a systematic review of major instrumental and auditory-perceptual assessments. Int Arch Otorhinolaryngol. 2013;17(03):251-256. doi:https://doi.org/10.7162/S1809-97772013000300004
7.
JacksonOStranskyCAJawadAFBastaMSolotCCohenMKirschnerRLowD-WRandallPLaRossaD, et al.The children’s hospital of Philadelphia modification of the Furlow double-opposing Z-palatoplasty: 30-year experience and long-term speech outcomes. Plast Reconstr Surg. 2013;132(3):613-622. doi:https://doi.org/10.1097/PRS.0b013e31829ad109
8.
de BlacamCSmithSOrrD. Surgery for velopharyngeal dysfunction: a systematic review of interventions and outcomes. Cleft Palate Craniofac J. 2018;55(3):405-422. doi:https://doi.org/10.1177/1055665617735102
9.
MASRenZ. Individualized management of velopharyngeal insufficiency for cleft lip and palate. Chin J Plast Surg. 2019:35-39.
10.
SandAHagbergELohmanderA. On the benefits of speech-language therapy for individuals born with cleft palate: a systematic review and meta-analysis of individual participant data. J Speech Lang Hear Res. 2022;65(2):555-573. doi:https://doi.org/10.1044/2021_JSLHR-21-00367
DemirözACelikUYalcinCEAydinY. Complicated patients with cleft lip and palate: our experience with multidisciplinary approach. Turk J Plast Surg. 2021;29(suppl 1):S14-S16. doi:https://doi.org/10.4103/tjps.tjps_77_20
13.
TachimuraTNoharaKFujitaYWadaT. Change in levator veli palatini muscle activity for patients with cleft palate in association with placement of a speech-aid prosthesis. Cleft Palate Craniofac J. 2002;39(5):503-508. doi:https://doi.org/10.1597/1545-1569_2002_039_0503_cilvpm_2.0.co_2
14.
PushpavathiMKavyaVAkshathaV. Impact of timing of surgery on the development of speech in toddlers with repaired cleft lip and palate.Springer. 2021:pp. 105-116.
15.
HeisterCDillonKBradyCSoldanskaMWilliamsJKMasonK. Understanding access to care: factors influencing patient attendance at craniofacial speech evaluations. Cleft Palate Craniofac J. 2025;62(2):201-213. doi:https://doi.org/10.1177/10556656241310203
16.
MasonKNKotlarekKJ. Where is the care? Identifying the impact of rurality on SLP caseloads and treatment decisions for children with cleft palate. Cleft Palate Craniofac J. 2024;61(12):1969-1980. doi:https://doi.org/10.1177/10556656231189940
17.
SugdenEBakerEMunroNWilliamsAL. Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence. Int J Lang Commun Disord. 2016;51(6):597-625.
18.
GussyMKilpatrickN. The self-concept of adolescents with cleft lip and palate: a pilot study using a multidimensional/hierarchical measurement instrument. Int J Paediatr Dent. 2006;16(5):335-341. doi:https://doi.org/10.1111/j.1365-263X.2006.00754.x
PopeAWWardJ. Factors associated with peer social competence in preadolescents with craniofacial anomalies. J Pediatr Psychol. 1997;22(4):455-469. doi:https://doi.org/10.1093/jpepsy/22.4.455
21.
HuntOBurdenDHepperPStevensonMJohnstonC. Self-reports of psychosocial functioning among children and young adults with cleft lip and palate. Cleft Palate Craniofac J. 2006;43(5):598-605. doi:https://doi.org/10.1597/05-080
ParkY-HJoH-JHongI-SLeemD-HBaekJ-AKoS-O. Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results. Maxillofac Plast Reconstr Surg. 2019;41(1):19. doi:https://doi.org/10.1186/s40902-019-0202-8
24.
ShinY-JKoS-O. Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report. Maxillofac Plast Reconstr Surg. 2015;37(1):22. doi:https://doi.org/10.1186/s40902-015-0022-4
25.
TachimuraTNoharaKFujitaYHaraHWadaT. Change in levator veli palatini muscle activity of normal speakers in association with elevation of the velum using an experimental palatal lift prosthesis. Cleft Palate Craniofac J. 2001;38(5):449-454. doi:https://doi.org/10.1597/1545-1569_2001_038_0449_cilvpm_2.0.co_2
26.
KoS-OShinH-K. Clinical assessment of the velopharyngeal incompetency speakers with speech aids. J Korean Assoc Oral Maxillofac Surg. 2000;26(4):414-421.
27.
Pegoraro-KrookMIRosaRRAferriHCAndradeLDutkaJ. Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate. Braz J Otorhinolaryngol. 2022;88(2):187-193. doi:https://doi.org/10.1016/j.bjorl.2020.05.028
28.
WadudATanveerWChotprasertNSrithavajT. Role of speech aid prosthesis as diagnostic and therapeutic aid for velopharyngeal insufficiency defect: a case report. Arch Orofac Sci. 2021;16(1):87-94. doi:https://doi.org/10.21315/aos2021.16.1.9
29.
HussainSAVijayakumarCBalasubramanianSRahavi-EzabadiSSundarVSybilDHussainZ, et al.Management of velopharyngeal dysfunction (VPD) following cleft palate repair: a comprehensive decision-making process based on severity and structural deficiencies. Cleft Palate Craniofac J. 2024. https://doi.org/10.1177/10556656231225573
30.
WogdenFNormanADibbenL. Treatment choice in adolescents with cleft lip and/or palate: the importance of shared decision-making. Cleft Palate Craniofac J. 2019;56(9):1220-1229. doi:https://doi.org/10.1177/1055665619848256
31.
GilleardOSellDGhanemAMTavsanogluYBirchMSommerladB. Submucous cleft palate: a systematic review of surgical management based on perceptual and instrumental analysis. Cleft Palate Craniofac J. 2014;51(6):686-695. doi:https://doi.org/10.1597/13-046
