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Clin Plast Surg. 2014 Apr;41(2):253-70. doi: 10.1016/j.cps.2013.12.010.

Surgical management of velopharyngeal insufficiency.

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Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North Saint Clair Street, Galter Pavilion, Suite 19-250, Chicago, IL 60611, USA. Electronic address:
Division of Plastic & Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA.


The primary goal of cleft palate repair is to create an anatomically and functionally intact palate while minimally affecting maxillary growth and development. In order to produce normal speech, a child must have velopharyngeal competence, defined as the ability to completely close the velopharyngeal sphincter that separates the oropharynx and nasopharynx. The absence of this ability, termed velopharyngeal insufficiency (VPI), is seen in a wide range of patients following primary cleft palate repair. This article discusses patient assessment, treatment options, and the surgical management of VPI. Recent trends and future directions in management are also presented.


Cleft palate; Furlow palatoplasty; Hypernasal speech; Pharyngeal flap; Sphincter pharyngoplasty; Surgical technique; Velopharyngeal insufficiency

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