Children with dysarthria are often seriously handicapped by their inability to communicate. Velopharyngeal incompetence may contribute to their speech difficulties but the indications for pharyngoplasty are poorly defined. The speech of 41 children, thought to have a defect of neurological origin and referred for possible pharyngoplasty, was assessed by a speech therapist, by nasopharyngoscopy and by multiview videofluoroscopy. These investigations revealed that 16 had velopharyngeal incompetence, with a neurological aetiology, and might be expected to benefit from pharyngoplasty. Independent assessment of the intelligibility of these 16 children before and after pharyngoplasty has been related to their preoperative oropharyngeal function. The majority benefited from surgery, some substantially. In particular, good lip and tongue function are shown to be necessary to achieve improved intelligibility. The roles of age, intelligence and aetiology in the success of pharyngoplasty are discussed.
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