Velopharyngeal insufficiency treatment usually involves speech therapy and surgery. Speech therapy can help your child adjust the way they speak to reduce the sounds of VPI. It’s often done before and after surgery. Surgery aims to create a better seal between the nasal and oral cavities without blocking the airway. Surgical approaches depend on the structural problems involved. A surgeon may: Change the shape of the soft palate. Expand the pharyngeal wall to decrease the distance to the soft palate. Lengthen or readjust the palate muscles. Take a flap of muscle from the back wall of the throat and attach it to the palate, called a pharyngeal flap procedure. Use fat injections or other fillers to help close the palate. Some people may wear an oral prosthetic, a custom-made device that pushes their palate higher (like a dental retainer after braces). But these are often difficult to tolerate and are usually used only in people who aren’t good candidates for surgery.