A 2026 meta-analysis found that pharyngeal flap surgery carries a pooled risk ratio of 2.45 (95% CI 1.20 to 5.01) for obstructive sleep apnea compared with other speech operations, even though the flap does no better than its rivals on speech. Average hypernasality improvement for the three leading techniques sits inside a 2.02-point band: 85.06% for Furlow palatoplasty, 84.50% for pharyngeal flap and 83.04% for sphincter pharyngoplasty (Fasahat et al., Cleft Palate-Craniofacial Journal 2026). The cost shows up later: in US commercial claims, 7.3% of 1,098 children developed obstructive sleep apnea after velopharyngeal surgery, at an average of 10.2 months after the operation (Rochlin et al., Plastic and Reconstructive Surgery 2021). This roundup goes deeper on the surgical side of the velopharyngeal insufficiency (VPI) story that our cleft lip and palate speech outcomes statistics cover at the population level. We aggregated data from the American Cleft Palate-Craniofacial Association (ACPA), the Cleft Palate-Craniofacial Journal, Plastic and Reconstructive Surgery, The Laryngoscope, the Journal of Oral and Maxillofacial Surgery, the ACS NSQIP-Pediatric registry and more than a dozen other peer-reviewed sources.
TL;DR
- Pharyngeal flap vs non-flap speech surgery: pooled obstructive sleep apnea risk ratio 2.45, 95% CI 1.20 to 5.01 (Best et al., Journal of Oral and Maxillofacial Surgery 2026).
- Average hypernasality improvement: Furlow 85.06%, pharyngeal flap 84.50%, sphincter pharyngoplasty 83.04%, buccal flap 59.69% (Fasahat et al., Cleft Palate-Craniofacial Journal 2026).
- No significant difference in VPI resolution between pharyngeal flap and sphincter pharyngoplasty across 10 articles and 531 patients (Shah et al., Journal of Craniofacial Surgery 2026).
- Approximately 15-25% of children born with cleft palate develop velopharyngeal dysfunction after palate repair (ACPA, Treatment Options for Better Speech).
- Complete clefts: VPI in 40% vs 13% of incomplete clefts, OR 4.35 (Scheepers et al., Plastic Surgery 2026).
- 33.1% of 166 sphincter pharyngoplasty patients needed a primary revision over a median 8.8 years of follow-up (Chin et al., JPRAS 2024).
- Polysomnography-confirmed sleep apnea at long-term follow-up: pharyngeal flap 22%, sphincter pharyngoplasty 23%, palatal muscle repositioning 3% (Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025).
- Further surgery, pharyngeal flap vs sphincter pharyngoplasty: OR 0.43, p = 0.010 (Rochlin et al., Plastic and Reconstructive Surgery 2021).
- 22q11.2 deletion: fully competent velopharyngeal score after pharyngeal flap in 60.0% vs 92.6% in cleft lip and palate (Wang et al., Plastic and Reconstructive Surgery 2024).
- Internal carotid artery medialization in 47.1% of patients with 22q11.2 deletion syndrome imaged before surgery (Duckett et al., The Laryngoscope 2024).
- Revision Furlow success: 85% of 110 patients (Prezelski et al., Cleft Palate-Craniofacial Journal 2024).
1. How Often VPI Follows Cleft Palate Repair
Published VPI rates after primary palatoplasty run from roughly one child in ten to more than one in three, and most of that spread is about who is in the cohort, not about measurement error. In a British Columbia cohort, children with a complete cleft palate developed VPI at 40%, against 13% with an incomplete cleft (OR 4.35, 95% CI 2.05 to 10.1) (Scheepers et al., Plastic Surgery 2026). For complete clefts, each additional month of age at palatoplasty raised the odds (OR 1.27 per month), while income, driving distance and ethnicity showed no significant association overall.
Associated conditions shift the baseline again. A 2024 systematic review of 19 studies pooled VPI at 36.1% in isolated Robin sequence against 25.6% in isolated cleft palate, though two thirds of the comparative studies inside it found no significant difference. Any surgical success rate in the sections below has to be read against this denominator: a technique tested in a 30% VPI cohort and one tested in a 10% cohort are operating on different children.
| Metric | Value | Source |
|---|---|---|
| Children with cleft palate who develop velopharyngeal dysfunction after palate repair | Approximately 15-25% | ACPA, Treatment Options for Better Speech (family resource) |
| VPI after primary palatoplasty, non-syndromic, British Columbia 2005-2015 | 30% (63 of 209); 98% of those with VPI had secondary surgery | Scheepers et al., Plastic Surgery 2026 |
| VPI by cleft extent | 40% complete vs 13% incomplete; OR 4.35 (95% CI 2.05 to 10.1), P < .001 | Scheepers et al., Plastic Surgery 2026 |
| Pooled VPI, isolated Robin sequence vs isolated cleft palate (19 studies) | 36.1% (95% CI 33.0-39.3%) vs 25.6% (95% CI 23.6-27.6%) | Sullivan et al., JPRAS Open 2024 |
| Pooled speech-correcting surgery, isolated Robin sequence vs isolated cleft palate | 19.6% vs 13.0% | Sullivan et al., JPRAS Open 2024 |
| Velopharyngeal competence at age 5, Sweden, births 2009-2018 | 87.5% cleft palate only; 60.7% Robin sequence with additional conditions (OR 0.24, 95% CI 0.10-0.56) | Klinto et al., Cleft Palate-Craniofacial Journal 2025 |
| Secondary palatal or velopharyngeal surgery before age 5, Sweden | 9.7% (42 of 433) | Klinto et al., Cleft Palate-Craniofacial Journal 2025 |
| Secondary velopharyngeal surgery, US academic center, 2014-2024 | 10.8% (27 of 251) | Williamson et al., The Laryngoscope 2026 |
Context: the ACPA range comes from a family booklet whose text carries a 2004 copyright, so treat it as a long-standing clinical rule of thumb rather than a fresh estimate. Most recent available data for a population-level range: ACPA, Treatment Options for Better Speech, 2004 text.
2. Hypernasality Resolution: Pharyngeal Flap vs Sphincter Pharyngoplasty vs Furlow
The 2026 pooled evidence lands on parity, not a winner. Furlow palatoplasty (85.06%), pharyngeal flap (84.50%) and sphincter pharyngoplasty (83.04%) sit within 2.02 percentage points of each other on average hypernasality improvement across 31 studies and 1,774 patients (Fasahat et al., Cleft Palate-Craniofacial Journal 2026). The real gap is at the bottom of the table, where buccal flaps averaged 59.69%. Heterogeneity reached an I2 of up to 100%, so these are averages over very different gap sizes and patient groups.
A separate 2026 meta-analysis of 10 articles found no significant difference between pharyngeal flap and sphincter pharyngoplasty on either VPI resolution or hypernasality. Timing changes the picture, though. A systematic review that pooled crude proportions without formal statistics recorded normal resonance after sphincter pharyngoplasty at 42% short-term but 69% long-term, while pharyngeal flap held at 81% and 80%. The choice is less about which operation works and more about which patient and gap each one suits.
| Metric | Value | Source |
|---|---|---|
| Average hypernasality improvement, 5 techniques (31 studies, 1,774 patients) | Furlow 85.06%; pharyngeal flap 84.50%; sphincter pharyngoplasty 83.04%; buccinator flap 77.61%; buccal flap 59.69% | Fasahat et al., Cleft Palate-Craniofacial Journal 2026 |
| VPI resolution and hypernasality, pharyngeal flap vs sphincter pharyngoplasty (10 articles, 531 patients) | No significant difference | Shah et al., Journal of Craniofacial Surgery 2026 |
| Normal resonance, short-term vs long-term follow-up (1,349 patients) | Pharyngeal flap 81% vs 80%; sphincter pharyngoplasty 42% vs 69%; palatal muscle repositioning 67% vs 72% | Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025 |
| Competent velopharyngeal function at long-term follow-up | Pharyngeal flap 82%; sphincter pharyngoplasty 69%; palatal muscle repositioning 77% | Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025 |
| Adequate velopharyngeal function, secondary Furlow vs pharyngeal flap, Finland 2002-2018 | 82% (289 of 351) vs 81% (21 of 26) | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
| Adequate function after secondary Furlow, nonsyndromic vs syndromic | 86% vs 67% (P < 0.001) | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
| Velopharyngeal dysfunction before vs after buccal flap (Ahl et al. 2016) | 68.5% to 24.1% | Arkoubi, Journal of Clinical Medicine 2025 (systematic review of 23 studies, 995 patients) |
Outlier note: the syndromic gap is wider than the technique gap. In the Finnish series, the difference between nonsyndromic and syndromic children after the same Furlow operation (86% vs 67%) is 19 percentage points, more than nine times the 2.02-point spread between the three main techniques in the pooled data.
3. Revision Rates and How Durable a VPI Repair Is
Success after one operation and success after several operations are different numbers, and many papers only report the second. Only 63.9% of sphincter pharyngoplasty patients improved and stayed improved after a single operation, while cumulative improvement reached 91.6% after up to three revisions in a two-center series with a median 8.8 years of follow-up (Chin et al., JPRAS 2024). US commercial claims reinforce the durability gap: pharyngeal flap carried less than half the odds of further surgery compared with sphincter pharyngoplasty (OR 0.43, see the table below).
For revision palatoplasty, patient selection beats technique loyalty. In 110 children who had a secondary Furlow, the preoperative velopharyngeal closure ratio was the only significant predictor of success, with an optimal cutoff of 55% (Prezelski et al., Cleft Palate-Craniofacial Journal 2024). Children with near-complete closure did very well; those with large gaps did little better than a coin flip.
| Metric | Value | Source |
|---|---|---|
| Primary revision after sphincter pharyngoplasty (166 patients, median follow-up 8.8 years) | 33.1% (55), at a median 3.9 years after surgery | Chin et al., JPRAS 2024 |
| Sustained improvement after one sphincter pharyngoplasty vs cumulative after revisions | 63.9% single; 87.3% after primary revision; 91.6% after tertiary revision | Chin et al., JPRAS 2024 |
| Further surgery, pharyngeal flap vs sphincter pharyngoplasty, US claims 2007-2016 (1,098 patients) | OR 0.43, p = 0.010 | Rochlin et al., Plastic and Reconstructive Surgery 2021 |
| Reoperation for residual VPI, after secondary Furlow vs after pharyngeal flap | 12% (41 of 351) vs 8% (2 of 26) | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
| Children needing two secondary velopharyngeal operations | 25.9% (7 of 27); median 24 months between first and second | Williamson et al., The Laryngoscope 2026 |
| Revision Furlow success (110 patients, 2012-2021) | 85% (94 of 110); CAPS-A-AM hypernasality 3.15 to 0.96 (P < .0001) | Prezelski et al., Cleft Palate-Craniofacial Journal 2024 |
| Revision Furlow success by preoperative closure | 93.8% above 90% closure vs 55.6% at 25-49% closure; ROC AUC 0.76 | Prezelski et al., Cleft Palate-Craniofacial Journal 2024 |
| C1 prominence below the palatal plane on MRI (34 children) | 97%, a mean 10.5 mm below; adenoid tissue at the palatal plane in 91% | Sitzman et al., Plastic and Reconstructive Surgery Global Open 2025 |
Context: the last row matters for pharyngeal flap placement. Surgeons often use the C1 prominence as a landmark for flap height, yet in Sitzman et al.’s MRI study it sat below the palatal plane in almost every child, which suggests a flap based on it may sit lower than intended.
4. Obstructive Sleep Apnea: The Airway Trade-off
Every operation that narrows the velopharyngeal port trades some airway for speech, and ACPA’s family guidance warns that a flap or sphincter can reduce the space more than desired, in extreme cases requiring another operation to remove tissue. Pharyngeal flap carried a pooled risk ratio of 2.45 (95% CI 1.20 to 5.01, P = .01) for postoperative obstructive sleep apnea against non-flap procedures (Best et al., Journal of Oral and Maxillofacial Surgery 2026). But the comparison with dynamic sphincter pharyngoplasty was not significant (P = .68). The meaningful line is between obstructing operations and palatal lengthening, which had a risk ratio of 0.39 relative to the flap.
The second lesson is timing. In US claims, sleep apnea surfaced an average of 10.2 months after surgery (Rochlin et al., Plastic and Reconstructive Surgery 2021), and in the long-term sphincter series the mean time to diagnosis was 4.4 years (Chin et al., JPRAS 2024). A clean sleep screen in the first postoperative months does not close the question. For the wider pediatric and adult picture, see our obstructive sleep apnea prevalence statistics.
| Metric | Value | Source |
|---|---|---|
| Postoperative sleep apnea, pharyngeal flap vs non-flap speech procedures (4 studies, 751 subjects) | Pooled RR 2.45 (95% CI 1.20 to 5.01), P = .01 | Best et al., Journal of Oral and Maxillofacial Surgery 2026 |
| Palatal lengthening vs pharyngeal flap; pharyngeal flap vs dynamic sphincter pharyngoplasty | RR 0.39, P = .002; P = .68 (not significant) | Best et al., Journal of Oral and Maxillofacial Surgery 2026 |
| Sleep apnea after VPI surgery, US commercial claims (1,098 patients) | 7.3% (80); sphincter pharyngoplasty 11.1% vs pharyngeal flap 7.2% (not significantly different) | Rochlin et al., Plastic and Reconstructive Surgery 2021 |
| Clinical sleep apnea symptoms at short-term follow-up | Pharyngeal flap 38%; sphincter pharyngoplasty 17%; palatal muscle repositioning 2% | Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025 |
| Sleep apnea on polysomnography at long-term follow-up | Pharyngeal flap 22%; sphincter pharyngoplasty 23%; palatal muscle repositioning 3% | Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025 |
| Sleep apnea before vs after sphincter pharyngoplasty; CPAP or BiPAP use before vs after | 3.0% vs 14.5% (p < 0.001); 1.2% vs 11.4% | Chin et al., JPRAS 2024 |
| Mild obstruction on polysomnography after secondary Furlow, Finland | 1% (5 of 351), managed with positional guidance only | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
Outlier note: the claims data ran opposite to the short-term symptom pattern in the systematic review, with a numerically higher rate after sphincter pharyngoplasty (11.1%) than after pharyngeal flap (7.2%). Neither the claims comparison nor the meta-analysis found a significant difference between the two obstructing operations, which is the consistent finding across sources.
5. 22q11.2 Deletion Syndrome: Different Anatomy, Different Odds
22q11.2 deletion syndrome affects an estimated 1 in 4,000 people according to MedlinePlus Genetics, yet it made up 8.5% of 3,227 US children aged 3 and older who had speech surgery in the NSQIP-Pediatric registry from 2013 to 2020 (Srinivas et al., Cleft Palate-Craniofacial Journal 2026). These children arrive sicker: higher ASA classes, more airway abnormalities, far more cardiac risk. Even so, the study’s title finding is that the diagnosis was not independently associated with complications once those factors were accounted for.
The speech results are where the gap shows. After pharyngeal flap, only 60.0% of children with 22q11.2 deletion reached a fully competent velopharyngeal score, against 92.6% of children with cleft lip and palate (P = 0.016), even though nearly all improved (Wang et al., Plastic and Reconstructive Surgery 2024). A small 2025 series suggests palatoplasty alone is a weak option in this group, and medialized internal carotid arteries change the surgical plan often enough that preoperative imaging is a practical necessity.
| Metric | Value | Source |
|---|---|---|
| Estimated prevalence, 22q11.2 deletion syndrome | About 1 in 4,000 people | MedlinePlus Genetics, National Library of Medicine (page updated 2019) |
| Share of US pediatric speech-surgery patients with 22q11.2 deletion, NSQIP-Pediatric 2013-2020 | 8.5% (273 of 3,227) | Srinivas et al., Cleft Palate-Craniofacial Journal 2026 |
| Airway abnormalities; cardiac risk factors, 22q11.2 vs other patients | 26.7% vs 14.2%; 56.4% vs 8.5% (both p < .0001) | Srinivas et al., Cleft Palate-Craniofacial Journal 2026 |
| Prolonged length of stay (more than 2 days) with 22q11.2 deletion | aOR 2.02 (95% CI 1.43-2.86) | Srinivas et al., Cleft Palate-Craniofacial Journal 2026 |
| Velopharyngeal function after pharyngeal flap, 22q11.2 vs cleft lip and palate | Fully competent 60.0% vs 92.6% (P = 0.016); improved 86.7% vs 100% (P = 0.122) | Wang et al., Plastic and Reconstructive Surgery 2024 |
| Hypernasality resolved at 12 months, palatoplasty vs pharyngoplasty (14 patients with 22q11.2) | 0 of 7 vs 6 of 7 (P = .03) | Williams et al., Cleft Palate-Craniofacial Journal 2025 |
| Internal carotid artery medialization on preoperative imaging (398 patients) | 47.1% (95% CI 29.2-65.5); operative plan changed in 19.4% (95% CI 5.7-38.8) of 254 surgeries | Duckett et al., The Laryngoscope 2024 |
| 22q11.2 deletion among children needing two vs one secondary velopharyngeal operation | 42.9% vs 5.0% (p = 0.042) | Williamson et al., The Laryngoscope 2026 |
Context: in the same 2026 Laryngoscope series, 4 of 13 children with a 22q11.2 microdeletion (30.8%) needed secondary velopharyngeal surgery, nearly three times the 10.8% rate in the full cohort, although the association lost significance in the multivariate model.
6. Practice Patterns, Less-Invasive Options and Recovery
Which operation a child gets depends heavily on where they are treated. Pharyngeal flaps made up 61.0% of VPI operations in US commercial claims and 52% in the British Columbia cohort, while a Finnish center used Furlow Z-plasty for 93% of 377 secondary VPI operations (Szwedyc et al., Journal of Craniofacial Surgery 2025). With pooled speech outcomes this close (see section 2), the choice is driven at least as much by team tradition and airway concerns as by measured superiority. Diagnostics are not standardized either: in a Dutch national survey, 6 of 7 responding cleft centers used no severity classification system.
Less-invasive options are growing at the edges. An integrated analysis of autologous fat injection reported a summative complication rate of 2.7% across 594 cases (Mirsky et al., Annals of Plastic Surgery 2024), and injection pharyngoplasty in adults with acquired VPI showed high patient-reported improvement, at the cost of repeat procedures. ACPA’s guidance adds a point no surgical table captures: closing the port does not automatically correct compensatory articulation, which still needs speech therapy, a service whose capacity is tracked in our speech-language pathologist workforce and caseload statistics.
| Metric | Value | Source |
|---|---|---|
| Procedure mix, US commercial claims 2007-2016 | Pharyngeal flap 61.0%; sphincter pharyngoplasty 22.2%; palatal lengthening with or without island flaps 16.8% | Rochlin et al., Plastic and Reconstructive Surgery 2021 |
| Procedure mix among children with VPI, British Columbia | Pharyngeal flap 52%; Furlow re-repair 32%; sphincter pharyngoplasty 16% | Scheepers et al., Plastic Surgery 2026 |
| Share of secondary VPI operations that were Furlow Z-plasty, Finland 2002-2018 | 93% (351 of 377) | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
| Dutch cleft centers (7 of 8 responding) offering each technique | Furlow, intravelar veloplasty and superior pharyngeal flap 5 of 7 each; posterior wall lipofilling 3 of 7 | Peters et al., Cleft Palate-Craniofacial Journal 2026 |
| Autologous fat injection for VPI (20 studies, 594 cases in complication analysis) | 2.7% summative complication rate; 78.2% of patients had a prior cleft palate diagnosis | Mirsky et al., Annals of Plastic Surgery 2024 |
| Injection pharyngoplasty in adults (30 patients, 61 injections) | 90% reported improvement; 14 of 30 needed more than one injection; no major complications | Kalra et al., European Archives of Oto-Rhino-Laryngology 2026 |
| Expected stuffy (hyponasal) speech after VPI surgery | 7-10 days or longer | ACPA, Treatment Options for Better Speech |
Context: the adult injection series is not a cleft cohort. Over half of its patients (16 of 30) had VPI after radiation or chemotherapy, so its results describe acquired VPI rather than the cleft population in sections 1 to 3.
Summary: Velopharyngeal Insufficiency Surgery by the Numbers
| Metric | Value | Source |
|---|---|---|
| Velopharyngeal dysfunction after cleft palate repair | Approximately 15-25% of children | ACPA, Treatment Options for Better Speech |
| VPI after primary palatoplasty, complete vs incomplete cleft | 40% vs 13% (OR 4.35) | Scheepers et al., Plastic Surgery 2026 |
| Pooled VPI, isolated Robin sequence vs isolated cleft palate | 36.1% vs 25.6% | Sullivan et al., JPRAS Open 2024 |
| Secondary palatal or VP surgery before age 5, Sweden | 9.7% | Klinto et al., Cleft Palate-Craniofacial Journal 2025 |
| Average hypernasality improvement, Furlow / pharyngeal flap / sphincter pharyngoplasty | 85.06% / 84.50% / 83.04% | Fasahat et al., Cleft Palate-Craniofacial Journal 2026 |
| Average hypernasality improvement, buccal flap | 59.69% | Fasahat et al., Cleft Palate-Craniofacial Journal 2026 |
| Pharyngeal flap vs sphincter pharyngoplasty on VPI resolution | No significant difference (10 articles, 531 patients) | Shah et al., Journal of Craniofacial Surgery 2026 |
| Adequate VP function, nonsyndromic vs syndromic after secondary Furlow | 86% vs 67% | Szwedyc et al., Journal of Craniofacial Surgery 2025 |
| Primary revision after sphincter pharyngoplasty | 33.1% | Chin et al., JPRAS 2024 |
| Revision Furlow success | 85%; 93.8% when closure exceeded 90% | Prezelski et al., Cleft Palate-Craniofacial Journal 2024 |
| Sleep apnea risk, pharyngeal flap vs non-flap procedures | RR 2.45 (95% CI 1.20 to 5.01) | Best et al., Journal of Oral and Maxillofacial Surgery 2026 |
| Sleep apnea after VPI surgery, US claims | 7.3% at an average 10.2 months | Rochlin et al., Plastic and Reconstructive Surgery 2021 |
| Polysomnography-confirmed sleep apnea long term, pharyngeal flap / sphincter / muscle repositioning | 22% / 23% / 3% | Chin, Haj et al., Craniomaxillofacial Trauma and Reconstruction 2025 |
| Sleep apnea before vs after sphincter pharyngoplasty | 3.0% vs 14.5% | Chin et al., JPRAS 2024 |
| 22q11.2 deletion share of US speech-surgery patients | 8.5% | Srinivas et al., Cleft Palate-Craniofacial Journal 2026 |
| Fully competent VP score after pharyngeal flap, 22q11.2 vs cleft lip and palate | 60.0% vs 92.6% | Wang et al., Plastic and Reconstructive Surgery 2024 |
| Internal carotid artery medialization in 22q11.2 deletion syndrome | 47.1% | Duckett et al., The Laryngoscope 2024 |
| Autologous fat injection complication rate | 2.7% | Mirsky et al., Annals of Plastic Surgery 2024 |
Methodology and Sources
- Fasahat et al., The Most Efficient Surgical Technique to Treat Velopharyngeal Insufficiency After Primary Cleft Palate Repair: A Systematic Review and Meta-Analysis (Cleft Palate-Craniofacial Journal 2026): 31 studies, 1,774 patients, five techniques.
- Shah et al., Pharyngeal Flap and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency in Cleft Patients: A Systematic Review and Meta-Analysis (Journal of Craniofacial Surgery 2026): 10 articles, 531 patients.
- Best et al., Do Pharyngeal Flaps Have a Greater Risk of Obstructive Sleep Apnea Than Other Speech Procedures? (Journal of Oral and Maxillofacial Surgery 2026): 4 studies, 751 subjects.
- Chin, Haj et al., Obstructive Sleep Apnea Following Secondary Velopharyngeal Insufficiency in Children with Non-Syndromic Cleft Palate: A Systematic Review (Craniomaxillofacial Trauma and Reconstruction 2025): 1,349 patients.
- Chin et al., Long-term outcomes of sphincter pharyngoplasty in patients with cleft palate (JPRAS 2024): 166 pharyngoplasties, two centers, 1992-2022.
- Rochlin et al., Rates of Revision and Obstructive Sleep Apnea after Surgery for Velopharyngeal Insufficiency (Plastic and Reconstructive Surgery 2021): IBM MarketScan, 1,098 patients.
- Szwedyc et al., Speech Outcomes After Secondary Furlow Z-Plasty and Pharyngeal Flap Procedure (Journal of Craniofacial Surgery 2025): 377 operations, Helsinki.
- Prezelski et al., Preoperative Velopharyngeal Closure Predicts Hypernasality Outcomes of Secondary Furlow Double-Opposing Z-Plasty (Cleft Palate-Craniofacial Journal 2024): 110 patients.
- Scheepers et al., Predictors of Poor Speech Outcomes Following Primary Palatoplasty (Plastic Surgery 2026): 209 patients, British Columbia.
- Sullivan et al., Velopharyngeal insufficiency after cleft palate repair in patients with isolated Robin sequence versus isolated cleft palate (JPRAS Open 2024): 19 studies.
- Klinto et al., Speech Outcomes in 5-Year-Olds Born With Cleft Palate With and Without Robin Sequence: A Swedish Registry Study (Cleft Palate-Craniofacial Journal 2025): 433 children.
- Williamson et al., Characterizing Secondary Velopharyngeal Surgery in Children With Cleft Palate at an Academic Center (The Laryngoscope 2026): 251 children.
- Sitzman et al., Creating a Superiorly Based Pharyngeal Flap (Plastic and Reconstructive Surgery Global Open 2025): MRI of 34 children.
- Srinivas et al., Diagnosis of 22q11.2 Deletion Syndrome is not Independently Associated with Complications Following Speech Surgery (Cleft Palate-Craniofacial Journal 2026): NSQIP-Pediatric, 3,227 patients.
- Wang et al., Comparative Study of Pharyngeal Flap Outcomes between Children with 22q11.2 Deletion Syndrome and Nonsyndromic Cleft Lip and Palate (Plastic and Reconstructive Surgery 2024): 76 children.
- Williams et al., Do Palatoplasty Procedures Resolve Hypernasality as Effectively as Pharyngoplasty Procedures in Patients with 22q11.2 Deletion Syndrome? (Cleft Palate-Craniofacial Journal 2025): 14 patients.
- Duckett et al., Preoperative Imaging in Patients with 22q11 Deletion Syndrome Undergoing Velopharyngeal Surgery (The Laryngoscope 2024): systematic review, 398 patients.
- MedlinePlus Genetics, 22q11.2 deletion syndrome (National Library of Medicine).
- Arkoubi, Investigating the Effectiveness of Buccal Flap for Velopharyngeal Insufficiency: A Systematic Review (Journal of Clinical Medicine 2025): 23 studies, 995 patients.
- Peters et al., Dutch Workflow for Diagnosis and Treatment of Velopharyngeal Insufficiency in Patients with Cleft Palate: A Survey Study (Cleft Palate-Craniofacial Journal 2026): 7 of 8 Dutch cleft centers.
- Mirsky et al., An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency (Annals of Plastic Surgery 2024): 20 studies.
- Kalra et al., Characterizing the safety and efficacy of injection pharyngoplasty as a treatment for velopharyngeal insufficiency in adults (European Archives of Oto-Rhino-Laryngology 2026): 30 adults.
- American Cleft Palate-Craniofacial Association, Treatment Options for Better Speech (ACPA Family Resources).
- Data watch: most technique comparisons rest on retrospective, single-center series with different speech scales (CAPS-A-AM, VPC-R, perceptual ratings), and Fasahat et al. report heterogeneity up to I2 100%, so pooled percentages are directional. Chin, Haj et al. pooled crude proportions without statistical testing, and their abstract (28 articles) and results (30 studies) disagree on study count. Szwedyc et al.’s abstract reports 12% sleep apnea after pharyngeal flap, while the results text records 1 mild case (4%) and 3 patients (12%) needing further surgical intervention. Kalra et al. report minor complications as 10 of 30 in the tables and 9 in the text. Rochlin et al. (2021) and the ACPA booklet text (2004 copyright) are older than three years and flagged as most recent available data; the pharyngeal flap vs sphincter pharyngoplasty sleep apnea comparison is where sources conflict most (short-term symptoms 38% vs 17% in Chin, Haj et al.; 7.2% vs 11.1% in Rochlin et al.; P = .68 in Best et al.), with no significant difference in the studies that tested it. 22q11.2 outcome studies are small (14 to 76 patients), and a 2023 preliminary systematic review comparing pharyngeal flap and sphincter pharyngoplasty in 22q11.2 has no full pooled results yet.
Last updated: October 18, 2026. We update this roundup quarterly, and the next refresh is expected when the Cleft Palate-Craniofacial Journal publishes its first 2027 issues and the 2027 ACPA annual meeting abstracts appear.