Methods: In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders. Results: Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68–0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73–1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 ± 0.32 scale points when judged by lay people, and 0.75 ± 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients. Conclusion: The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.

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