Background: Increasing evidence suggests submucous cleft palate (SMCP) is not simply a milder form of cleft palate, as some have described worse speech outcomes in SMCP, possibly due to greater syndromic association. Comparing SMCP with other cleft types is confounding, as waiting for clinically detectable velopharyngeal incompetence (VPI) makes SMCP patients older at time of surgery. One approach for a control group is to look at patients with isolated cleft palate only (CPO) who have persistent VPI after their initial primary repair, as the patho-anatomy is analogously a nonclefted palate with VPI.