The outcome of long-term follow-up after palatoplasty. 
The speech outcome was studied retrospectively in 140 cleft-palate patients who underwent push-back palatoplasty.  Velopharyngeal function and articulation disorders were evaluated serially at 4, 7, 10, and more than 10 years of age.  On comparison of velopharyngeal function between 4 years of age and the most recent review (>10 years), it was unchanged in 90 patients (64.3 percent), whereas it showed deterioration in 14 patients and showed improvement in 8 patients.  The other 28 patients underwent pharyngeal flap surgery; this group also included patients with functional deterioration.  Changes of velopharyngeal function often occurred between 4 and 7 years of age but sometimes occurred after 10 years of age.  Articulation disorders were observed in 49 subjects (35.0 percent) at 4 years of age.  Many of the patients with glottal stop showed improvement from 4 to 7 years of age.  Palatalized articulation showed less improvement than glottal stop (p < 0.01).  The number of patients with articulation disorders decreased significantly between 4 years of age and the most recent review (p < 0.001).  These findings suggest that speech does not become stable before 10 years of age and that patients with cleft palate should be carefully followed until they are beyond this age.