LAUSR

BACKGROUND Submucous cleft palate (SMCP) is a particular subtype of cleft deformity with the optimal surgical timing and technique still under debate. This study aimed to identify potential prognostic factors for the speech outcome of patients with SMCP and provide evidence for further management strategy optimization. METHODS We reviewed patients with nonsyndromic SMCP who received either Furlow palatoplasty (FP) or posterior pharyngeal flap (PPF) between 2008 and 2021 in a tertiary hospital-based cleft center. Both univariate and multivariate logistic regression models were employed to screen preoperative variables including cleft type (overt or occult), age at surgery, mobility of velum and pharyngeal wall, velopharyngeal closure ratio and pattern. Receiver operating characteristic curve was utilized to determine the cut-off value of the significant predictors for subgroup comparison. RESULTS A total of 131 patients were enrolled, with 92 receiving FP and 39 receiving PPF. Age at operation and cleft type were identified with significant impacts on FP outcome. Patients operated before 9.5 years demonstrated significantly higher velopharyngeal competence (VPC) rate than those operated after. The speech outcome among patients with occult SMCP was significantly worse than overt cases after FP treatment. No preoperative variable was found as correlated with PPF outcome. PPF yield higher VPC rate than FP among patients operated above 9.5 years. CONCLUSIONS The prognosis of FP treated SMCP patients is sensitive to age at surgery and cleft type. PPF may be considered for aged patients in settings with limited access to multiple surgeries, especially when occult SMCP is diagnosed.