Precision Decisions

For children diagnosed with velopharyngeal dysfunction (VPD), a disorder that causes air and sound to leak into the nasal passages, surgery provides the best opportunity for normal speech. But, for one in five of them, their first operation isn’t successful—and subsequent surgeries often fail too.

Kazlin Mason, assistant professor at the School of Education and Human Development, is looking to increase the odds of successful initial VPD surgeries. With support from The Hartwell Foundation, she is pioneering a collaborative and multifaceted approach to evaluate and treat children affected by VPD. By using new surgical techniques and more effective imaging tools to improve clinical decision-making, she hopes to ensure, as she puts it, “the right surgery for the right child at the right time.”

Mason received an Individual Biomedical Research Award from The Hartwell Foundation in 2025, which provides research support for three years at $100,000 direct cost per year. The Foundation supports early-stage researchers pursuing biomedical research with the potential to benefit children.

“Professor Mason’s award-winning proposal represents early-stage, innovative, and cutting-edge technology in medicine and biomedical engineering,” said Fred Dombrose, president of The Hartwell Foundation. “If she is successful in identifying patient-specific indicators for successful speech and surgical outcomes, it will transform clinical care for children with craniofacial conditions by moving away from highly subjective judgments to empirical evidence-based decisions, changes that will improve their speech and ability to communicate effectively.”

Mason says the impact of The Hartwell Foundation’s support is considerable. “It gave me the freedom to pursue bold, early-stage ideas that will ultimately make a real difference for children’s health,” she said.

In addition to funding from The Hartwell Foundation, Mason is benefiting from interactions with other early-stage scientists also conducting cutting-edge research. “It’s been amazing to be part of a collaborative network,” she said.

She is also partnering with UVA colleagues in material science, biomedical engineering, surgery, imaging, and speech pathology in her quest to improve VPD treatment. “It’s truly a cross-disciplinary effort,” she said.

Too Little Information, Too Many Operations

In those diagnosed with VPD, the craniofacial anatomy and speech musculature is fundamentally altered. This makes speech difficult to understand. The condition is usually found in children with cleft palate but is also caused by treatments for head and neck cancers.

There are two phases to treating VPD. The first is assessing the child’s speech function. Currently, a small camera is inserted through the nose to do this. The patient then speaks so clinicians can observe movement of the patient’s speech mechanism. “You can imagine how well that goes with most four-, five-, or six-year-olds,” Mason said.

The captured images are reviewed to determine the appropriate treatment. “The success of that imaging assessment is low to begin with and the interpretation of it is pretty subjective,” Mason said. “You get a lot of variability from clinician to clinician and patient to patient.” That means that the best surgical intervention may not be identified, which can lead to multiple operations and poor speech outcomes.

“These are kids,” Mason said. “You don’t want to do repeated surgeries. Every surgery is an anesthesia event. They’re out of school, there’s recovery, there’s costs associated with it. You want it to be the right surgery right off the bat.”

Better Insight, Fewer Surgeries

Through precision medicine, Mason hopes to improve current surgical methods using MRI imaging and computational modeling. “I’m doing multipronged research, looking at surgical innovation and different imaging tools to see how we can change the clinical decision-making process before surgeries,” Mason said.

It all starts with improving assessment. “I’m hoping to take the imaging component and make it much more objective and quantifiable by using MRI,” she said. This noninvasive method provides live three-dimensional images of a child’s precise anatomy during speech, providing clinicians with a wealth of data that can be used to create a digital representation of a specific child’s speech mechanism. “We’re then able to see how different surgeries will impact how that anatomy functions,” Mason said.

Mason is also investigating a new surgical procedure using a hydrogel-based biomaterial, developed by collaborators at UVA. The substance is placed in patients’ throats and palates, where it acts as a base from which natural tissue will regenerate and close the gap causing speech dysfunction. “It’s a much less invasive, and potentially more durable surgical approach that has a shorter healing time,” she explained.

Although her work is in its early phase, Mason is optimistic. As the biomaterial approaches human trials and the new imaging techniques are being piloted, “the outcomes look good,” she said. “If this is successful, it’s going to reduce the total number of surgeries that children with craniofacial conditions need to achieve normal speech.”