# Velopharyngeal insufficiency following cleft palate repair: a comparative effectiveness study of existing surgical procedures and identification of criteria to guide a personalized treatment approach

> **NIH NIH U01** · PHOENIX CHILDREN'S HOSPITAL · 2020 · $842,190

## Abstract

Velopharyngeal insufficiency (VPI) occurs in up to 40% of patients following cleft palate repair and results in
hypernasality and nasal air emission during speech, which substantially limits communication. VPI has
traditionally been treated with pharyngoplasty, which is over 80% effective but leads to obstructive sleep apnea
(OSA) in 15%–50% of patients. To avoid the risk of OSA, some surgeons have begun performing palate re-repair to treat VPI. Early experience suggests re-repair is 84% effective in resolving VPI and that it does not
lead to OSA, although results vary substantially depending upon the criteria for patient selection. Given the
potential of re-repair to reduce the risk of OSA, and the substantial limitations in our knowledge about its
effectiveness, there is a critical need to compare the effectiveness of palate re-repair to pharyngoplasty and to
determine which patients are most likely to benefit from each operation. This proposal addresses this need
through three specific aims: (1) Compare the effectiveness of palate re-repair with that of pharyngoplasty for
treating VPI. (2) Determine the anatomic abnormalities of the palate that predict resolution of hypernasality
following palate re-repair and following pharyngoplasty. (3) Identify barriers and facilitators to implementing
personalized VPI procedure selection. Aims 1 and 2 will be achieved by conducting an observational
comparative-effectiveness study of palate re-repair versus pharyngoplasty in patients with VPI following their
initial cleft palate repair. The study will enroll 528 participants over a 3-year period from 10 cleft centers, using
propensity score matching to control for known factors or those suspected of influencing surgical procedure
assignment and speech outcome after surgery. Aim 1 will compare the two procedures for the outcomes of
hypernasality, nasal air emission, and OSA at 12 months after VPI surgery. An overall comparison of
procedures will be performed, as will subgroup analyses for patients with specific exam and morphologic
criteria. Aim 2 will be achieved by obtaining velopharyngeal MRI on participants prior to VPI surgery; MRI
enables direct evaluation of the velar muscles and soft tissues responsible for VPI. Aim 2 will test whether the
anatomic anomalies of velar muscle dehiscence, velar muscle malposition, and/or a short velum, as visualized
on MRI, predict resolution of hypernasality following palate re-repair. Aim 3 will use implementation science
methods to understand providers’ current approach to VPI procedure selection, identifying factors that may
delay or encourage implementation of a personalized approach to VPI management built upon findings in Aims
1 and 2. Completion of these aims will provide the first direct comparison of palate re-repair to pharyngoplasty
for the treatment of VPI, establish the morphologic and anatomic features that predict successful treatment
with each procedure, and identify barriers and facilitators to implem...

## Key facts

- **NIH application ID:** 10030375
- **Project number:** 1U01DE029750-01
- **Recipient organization:** PHOENIX CHILDREN'S HOSPITAL
- **Principal Investigator:** Thomas James Sitzman
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $842,190
- **Award type:** 1
- **Project period:** 2020-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10030375

## Citation

> US National Institutes of Health, RePORTER application 10030375, Velopharyngeal insufficiency following cleft palate repair: a comparative effectiveness study of existing surgical procedures and identification of criteria to guide a personalized treatment approach (1U01DE029750-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10030375. Licensed CC0.

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