Speech outcomes following Orticochea pharyngoplasty in patients with cleft and non-cleft velopharyngeal dysfunction
Lead researcher: Patricia Rorison
Institutions: Great Ormond Street Hospital for Children and Birmingham Children's Hospital, Birmingham Children and Women's NHS Foundation Trust
Following cleft palate repair, some children continue to have problems with their speech. These problems often occur because the soft palate doesn’t move well enough to stop air coming through the nose when it should all come through the mouth during speech (this is called ‘velopharyngeal dysfunction’). For example, when saying the ‘p’ or ‘b’ sound all the air should come through the mouth. To make this happen, the soft palate has to move and close against the back of the throat, thus stopping any air coming down the nose.
There are also children who don’t have a cleft palate but who do have the same problem with their soft palate not working as well as it should. This is called non-cleft velopharyngeal dysfunction.
An Orticochoea pharyngoplasty is an operation on the back of the throat designed to help children stop the air coming down their noses when they don’t want it to during speech.
The aim of this project is to assess how effective Orticochoea pharyngoplasty is in improving speech in children with both cleft and non-cleft velopharyngeal dysfunction. It is a retrospective review of 103 children operated on by a single surgeon between 2008 and 2021, and with a minimum of 6 months’ follow up. Speech will be assessed both before and after surgery by independent specialist listeners who are blinded as to whether the speech they are hearing is from before or after the surgery.
The results of this study that CLEFT is funding will add high quality information about how effective the Orticochea Pharyngoplasty operation can be, and therefore help surgeons decide when and whether to use this operation. The information will be shared by presentation at meetings and by publication in cleft journals.
This research project is now complete, and we're delighted to share the findings.
The team reviewed the records and speech recordings of 89 patients treated across two specialist NHS cleft centres - Great Ormond Street Hospital and Birmingham Children's Hospital - all operated on by a single surgeon over a period of more than a decade. Of these, 50 patients had recordings that were of sufficient quality to be assessed. Both children who had previously had cleft palate surgery and those with similar speech difficulties but no cleft were included in the study.
The results are very encouraging. 86% of patients showed a clear improvement, moving from noticeably nasal speech to either normal or near-normal speech tone. Near-normal in this context means the difference would only be detectable to a trained specialist - to most listeners, it would sound entirely normal. There were no serious side effects from the surgery, and no significant difference in outcomes between the cleft and non-cleft groups.
One of the practical challenges the team faced during the project was tracking down speech recordings stretching back 16 years. Over that time, recording technology had changed significantly - from VHS video and minidisc through to CD and digital formats - and finding equipment to replay the older recordings proved difficult. Some more recent recordings were also missing due to remote consultations during the COVID pandemic. Despite this, the team worked hard to ensure all usable recordings were assessed rigorously, with an independent external check carried out on 10% of them.
The Orticochea technique has been in use for over 50 years but is not widely used across UK cleft units. This study - which reviewed the largest group of patients treated by a single surgeon yet reported in the scientific literature - provides strong evidence that it is a safe, effective and versatile option, including for patients whose previous surgery has not fully resolved their speech difficulties. The research team hopes the findings will encourage more cleft surgical units to consider using it, giving more patients a real chance of improving their speech and quality of life.
Results have been presented at several major international conferences, including the International Congress on Cleft Palate and Related Craniofacial Anomalies in Kyoto, Japan (October 2025), the European 22q11 Conference in Brussels (November 2025), and the Craniofacial Society of Great Britain & Ireland meeting in Newcastle (April/May 2026). A research paper for publication is currently in preparation.
CLEFT is grateful to Patricia Rorison and the whole research team for their commitment to this project - and for the difference their findings will make to children, families and clinical teams in the future.