Beyond Prevalence: Understanding the Relationship Between Early Anatomic Factors and the Likelihood for Cleft Speech Characteristics.

The study is observational, so it identifies associations but cannot prove that anatomic factors directly cause speech errors. Sample sizes dropped in the most complex models (down to 116 participants), reducing the precision of estimates for combined factors. Fistula data was binary (present/absent) without details on size or location, which limits understanding of how specific fistula types affect different speech errors. Velopharyngeal function and dental occlusion were not assessed at the same time point, so their potential confounding effects are unknown. Surgical technique and timing were not fully controlled, though most children had similar primary repairs.

The authors declared no conflicts of interest. Funding was provided by The Scar Free Foundation, the Underwood Trust, the Vocational Training Charitable Trust, and the National Center for Advancing Translational Sciences.

Do not assume that all cleft speech characteristics in children with bilateral clefts or fistulas are learned errors requiring speech therapy. Passive errors in these groups are strongly associated with anatomic factors and may require surgical intervention for fistula or velopharyngeal dysfunction.