Speech prosthesis versus pharyngeal flap: a randomized evaluation of the management of velopharyngeal incompetency.

Thirty-nine children with moderate-to-severe velopharyngeal incompetency were randomly assigned to either prosthetic or surgical palatal management. A classification for evaluating velopharyngeal incompetency was designed. The prosthetic speech appliance, when obtained and tolerated, corrected velopharyngeal incompetency as effectively as did pharyngeal flap surgery. However, the noncompliance and failure rate for prosthetic management was 35 percent. The surgical failure rate was 9 percent. Furthermore, 33 percent of patients who received prosthetic management have subsequently undergone pharyngeal flap surgery. The equivalency of these types of palatal management lead one to question the combination of the noncompliance and failure rate for prostheses, the incidence of secondary surgical conversions, and the persistent sense of deformity with prosthetic management.