ISRCTN29932826.

Overall weighted or composite variables for perceptual auditory estimation of velopharyngeal closure or competence have been used in several studies for evaluation of velopharyngeal function during speech. The aim of the present study was to investigate the validity of a composite score (VPC-Sum) and of auditory perceptual ratings of velopharyngeal competence (VPC-Rate). Available VPC-Sum scores and judgments of associated variables (hypernasality, audible nasal air leakage, weak pressure consonants, and non-oral articulation) from 391 5-year olds with repaired cleft palate (the Scandcleft project) were used to investigate content validity, and 339 of these were compared with an overall judgment of velopharyngeal competence (VPC-Rate) on the same patients by the same listeners. Significant positive correlations were found between the VPC-Sum and each of the associated variables (Cronbachs alpha 0.55-0.87, P < 0.001), and a moderately significant positive correlation between VPC-Sum and VPC-Rate (Rho 0.698, P < 0.01). The latter classified cases well when VPC-Sum was dichotomized with 67% predicted velopharyngeal competence and 90% velopharyngeal incompetence. The validity of the VPC-Sum was good and the VPC-Rate a good predictor, suggesting possible use of both measures depending on the objective.

Introduction: Maxillary advancement may affect speech in cleft patients. The aim of this study was to evaluate whether preoperative velopharyngeal (VP) function and cleft type can predict VP function after a Le Fort I maxillary osteotomy. Materials and methods: One hundred consecutive nonsyndromic cleft patients (54 females, 64 males) who underwent Le Fort I osteotomies were retrospectively evaluated. Pre-and postoperative VP function was assessed perceptually and instrumentally by a Nasometer. A five-point scale was used to rate velopharyngeal insufficiency symptoms (VPI 0e4). To assess reliability, 30 video recordings were reevaluated. Results: Preoperatively, 89% of patients had normal or insignificant VPI (0e1), and only 3% had moderate VPI (3). Postoperatively, 77% of patients had VPI values of 0e1 and 14% had moderate to severe VPI values (VPI 3e4). A positive correlation was found between pre-and postoperative VPI scores, whereas the cleft type did not affect speech results. Patients with a preoperatively normal VPI (0) were not at risk for postoperative velopharyngeal incompetence. Conclusions: There was an overall significant negative change in speech after a Le Fort I osteotomy. Atrisk patients presented with borderline (1) or more severe VPI (2 and 3) preoperatively.

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