Speech Outcomes Based on Early versus Delayed Repair of Submucous Cleft Palate

Monday, October 19, 2026

8:18 AM - 8:24 AM PT

Location: 409AB

Presenting Author(s)

Brooke B. Swain, BS

Medical Student
Vanderbilt University School of Medicine
Mobile, AL, United States

Co-Author(s)

Kalpnaben R. Patel, MD,CCRP

Pediatric Otolaryngology Research Coordinator
Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
Franklin, TN, United States
James D. Phillips, MD

Associate Professor
Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
Brentwood, Tennessee, United States

Senior Author(s)

Ryan H. Belcher, MD, MPH

Associate Professor
Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):

Brooke B. Swain, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kalpnaben R. Patel, MD,CCRP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan H. Belcher, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Submucous cleft palate (SMCP) is a defect of the soft palate musculature, causing hypernasality, articulation errors, and velopharyngeal insufficiency (VPI). While surgery can be delayed until the onset of speech symptoms, earlier interventions may improve outcomes. This single-institution retrospective study evaluates the relationship between age at SMCP repair and postoperative speech results.

Methods: Pediatric patients ( < 18 years) who underwent SMCP surgical repair from 2010-2025 were included. Patients who were non-verbal or managed non-operatively were excluded. Patients were grouped by age at repair: 0-2 years, 3-5 years, and > 6 years. Primary outcomes included hypernasality, articulation errors, secondary speech surgeries, and clinically assessed speech outcomes. Outcomes were compared across age groups using Fisher’s exact test.

Results: A total of 39 patients met inclusion criteria, with 18 (46.2%) repaired at 0-2 years, 14 (35.9%) at 3-5 years, and 7 (17.9%) at > 6 years. Median clinical follow-up was 3.65 years (IQR 1.01-6.88 years). Median speech-pathology follow up was 2.88 years (IQR 0.95-6.80 years). At last speech-pathology evaluation, patients repaired at 0-2 years demonstrated similar rates of hypernasality (30.8% vs 42.9% vs 40.0%, p=0.886) and a trend towards fewer articulation errors (21.4% vs 64.3% vs 40.0%, p=0.070) compared with older repair groups. Secondary speech surgery rates were low across all age groups (11.1% vs 14.3% vs 0.0%). Clinically detected speech issues were less frequent among patients repaired at 0-2 years compared to those repaired at later ages (22.2% vs 57.1% vs 42.9%, p=0.117).

Conclusions: Earlier SMCP repair during early childhood was associated with favorable trends in postoperative speech outcomes, including fewer articulation errors and reduced clinically detected speech issues. Earlier intervention may be associated with fewer articulation errors by preventing the development of compensatory speech patterns during early speech acquisition.