Surgery for velopharyngeal insufficiency.

Velopharyngeal inadequacy may be learned, neurologic, or anatomic in origin. Velopharyngeal insufficiency specifically refers to an anatomic deficiency, which subsequently impairs resonant control of speech and intraoral pressure for orally directed speech sounds. Preoperative speech therapy is useful, and in some children may provide definitive treatment. However, surgery is the foundation of effective treatment in most patients with anatomic defects and, when used appropriately, has been shown to result in resolution of velopharyngeal insufficiency in 62-98% of cases. In this chapter, the authors review velopharyngeal inadequacy and discuss the techniques necessary for successful surgical treatment.