Treatment options for the immobile postoperative palate include palatal training, palatal appliances, posterior pharyngeal wall augmentation, and further surgical correction. Cole has classified palatal training measures into indirect, semidirect and direct. Indirect methods include speech therapy with articulation training, and biofeedback from acoustic and endoscopic data. Semidirect methods employ non-speech exercises such as sucking, swallowing and gagging. Effects only last as long as therapy continues and only a poor carry-over to speech can be expected.
Direct measures use stimulation of the palatal musculature itself.
Techniques using inflatable velopharyngeal prostheses, tactile stimulation, and electrical stimulation of individual muscles have limited success rates long- term. Palatal appliances are indicated in patients unable to undergo anesthesia for surgical repair, with badly scarred postoperative palates, in patients refusing surgery, and with persistent palatal fistulae. Posnick reports using the palatal prosthesis to predict surgical outcomes prior to secondary repairs of the soft palate. Marsh and Wray found an equal success rate in children treated with palatal prostheses or surgery if compliance was maintained. Pharyngeal augmentation can be used in patients with mild velopharyngeal insufficiency with an anteroposterior velopharyngeal gap of less than five centimeters, provided lateral pharyngeal wall mobility is adequate.