<unk>  may be able to improve speech performance in children or adults with a cleft palate who have velopharyngeal insufficiency. In fact, there is a high success rate for improvement of speech following<unk> . However,<unk>  does not guarantee perfect or 100% intelligible speech. In addition to speech improvements,<unk>  may help eliminate hypernasality, nasal turbulence, and facial grimacing (Tonz et al., 2002). Often, speech improvements are not obvious immediately following the<unk> . Speech improvements are more prevalent after one year post<unk>  and usually continue for several years. The outcomes of<unk>  vary among each individual in regards to improvements in hyponasality, hypernasality, nasal turbulence, voice quality, articulation, and intelligibility (Tonz et al., 2002; Liedman-Boshki et al., 2005). Patients who undergo<unk>  encounter the risk of never breathing through their nose again, which could create abnormal speech (i.e., denasal resonance) (Witt et al., 1998). It is estimated that around 20-30% of patients with clefts develop hypernasal speech after<unk>  (Heliovaara et al., 2003). The percentage reported for individuals developing hypernasal speech is debated by researchers. It is possible that hypernasality can be a side effect of<unk> , however hyponasal speech occurs more frequently after a successful<unk>  (Liedman-Boshki et al., 2005). It is also possible that<unk>  will be unsuccessful. Some patients may even require secondary<unk>  for velopharyngeal insufficiency. It is common that individuals who have to undergo a second<unk>  could develop secondary speech problems, more specifically compensatory articulation and resonance disorders. Problems occurring post secondary<unk>  are often more difficult to extinguish (Tonz et al., 2002). As previously mentioned, one problem that may occur after<unk>  is hypernasality. This is caused when a narrow<unk>  and inadequate lateral<unk>  wall movement prohibit lateral port closure during phonation. There are several other reasons<unk>  may fail the first time, including a poorly designed<unk>  such as one that is too narrow, postoperative scar (contracture of the<unk> , or inappropriate patient selection. Also, the<unk>  may be too wide and occlude the lateral ports. There are higher rates of surgical failure in children with a history of perinatal upper airway obstruction, such as those with Robin sequence (Witt et al., 1998). The type of cleft, as well as the type of<unk>  used (superiorly or inferiorly-based) does not seem to make a difference in postoperative speech outcomes. It has been reported that different types of<unk> s give different speech configurations, however the results showed equally good outcomes for postoperative speech, regardless of the type of<unk>  used. Therefore, it is imperative that the surgeon selects the right type of<unk>  for each individual (Liedman-Boshki et al., 2005). Overall, speech should improve after<unk> . It is important to remember that improvement is variable and individuals react to<unk>  differently. Changes in speech do not always occur immediately after<unk> , but this does not mean improvements will not be made. Lastly, speech problems such as compensatory articulation strategies do not often extinguish on their own. A speech language pathologist is usually involved both before and after<unk>  to monitor and help improve speech difficulties.
Pharyngeal flap surgery
Rhinoplasty
Non-surgical rhinoplasty
Frenuloplasty of tongue
Alveolar cleft grafting
Chondrolaryngoplasty
Facial implant
Palatal lift prosthesis