The influence of an open residual cleft in the hard palate on speech was studied in nine children with cleft lip and palate at about 7 years of age. The subjects were treated by early repair of the velum (before 12 months of age), whereas the repair of the cleft in the hard palate was postponed until about 8 years of age. Speech and velopharyngeal function were assessed systematically with the residual cleft open and temporarily covered with an oral bandage. Listeners' judgments, the Nasal Oral RAtio Meter (NORAM), videofluoroscopy, and cephalometrics were used for the analyses. Four patients were also examined with a pressure-flow technique. Nasality registered by NORAM, nasal escape, and weak pressure consonants judged by listeners were common but decreased appreciably when the residual cleft was covered. Retracted articulation was found in four patients (44%) and glottal compensations In one (11%), with no improvement after covering.
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