Over the last 5 years in the University of Utah, approximately 65% of the operations for velopharyngeal insufficiency have been performed using a sphincter pharyngoplasty technique. Another 20% of patients have been treated with a posterior wall augmentation technique, and approximately 15% have been treated with the palatal attachment of a pharyngeal flap. This is primarily because most patients have better motion of the soft palate/ anterior pharyngeal wall than of the lateral pharyngeal wall. Consequently, pharyngoplasty usually fits the velopharyngeal defect better.

Successful velopharyngeal surgery is dependent on several factors. Preoperative evaluation is critical in determining the defect present and selection of the proper technique. Proper technical performance of the operation so that the surgical closure is matched to the defect and at the proper vertical level in the nasopharynx requires attention to detail. Postoperative evaluation of the results is extremely helpful to improve the quality of care being delivered. Postoperative assessment using nasopharyngoscopy and nasometry helps the surgeon to evaluate how the surgical result interacts with the velopharynx. At our center, this postoperative assessment is performed at 3 months. Close cooperation with a speech and language pathologist who also specializes in velopharyngeal disorders is helpful. Such consultation provides another and sometimes less biased opinion. Coexisting speech and language problems, may be recognized, and feedback is provided as to the final result.