From 1991 until 1998, 55 three to twelve year-old patients underwent a velopharyngoplasty to correct velopharyngeal insufficiency. They had indeed severe hypernasality with or without gross reflux of food matter into the nasal cavities or behavioural disturbances. Eighty-two percent had a closed cleft palate. Forty percent presented with mental retardation, heart diseases or multiple syndromal defects. They all had had a previous speech therapy for a long (months) or a very long (years) period of time. In the post operative period, hypernasality disappeared totally or partially in eighty-five percent; reflux disappeared in almost all cases. Middle ear pathologies were not more frequent and were also less severe. Behavioral disturbances associated with a severe speech defect were also less pronounced.
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