Some authors advocate the use of secondary palatoplasty with intravelar veloplasty as a first option for the VPI treatment, since the procedure is considered more physiological. Thus, those patients requiring future pharyngeal flap surgery after intravelar veloplasty may present a more favorable velopharyngeal condition avoiding the use of large flap and its undesirable effects on breathing. Objective: To investigate whether patients underwent secondary palate surgery in two stages, first intravelar veloplasty and, after pharyngeal flap surgery presented better speech resonance than those underwent only pharyngeal flap surgery. Methodology: Nasality outcomes obtained by means of perceptual-auditory assessment and nasometry, of at least 40 patients with repaired cleft palate will be analyzed: 20 underwent pharyngeal flap only (PF group) and 20 underwent intravelar veloplasty prior to pharyngeal flap (Group IV+PF) considering at least 6 months between surgeries. Hypernasality was rated using a 4 point scale (1 = balanced oronasal resonance and 4 = severe hypernasality) by means of in situ perceptual-auditory assessment. Nasalance scores were determined during the reading of a set of five sentences containing exclusively oral sounds considering the cut-off score of 27%. The significance of differences in postoperative findings between the two groups will be analyzed using the t test, with a significance level of 5%.
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