If the child is not physically capable of making VP closure then two alternatives are considered. The history of the recognition of velopharyngeal insufficiency VPI as a disorder of speech production that can be diagnosed and treated is a long one, and considerable literature has been devoted to it. This valve is made up of the following structures: One study reported a year experience on the efficacy of sphincter pharyngoplasty for velopharyngeal insufficiency repair, using need for surgical revision as the primary outcome measure. Support for your whole family. Clinical findings are consistent with velocardiofacial syndrome.