Little M’s father asked] I heard that children with cleft palate like ours have to have an articulation surgery when they are 4 or 5 years old if they can’t speak clearly? Is that true? Is it true that after the surgery, the child will be able to speak well? The articulation surgery Little M’s father asked about is called “pharyngectomy” in medical science. So, where is this surgery performed? Let me explain it to you with the following picture. When we open our mouth wide in the mirror, we will see the innermost part of the mouth, which is called the “uvula” by the people. The approximate location of the surgery is right there, so it is very far back. This “little tongue”, plus a part of the muscle in front of it, is soft and is called the “soft palate” (you can lick it if you don’t believe me). You may not know, although it is soft, but very flexible, can be a movement up and down (you can try to say “ah”, you can see it in the movement). So, why should we operate on him? Isn’t it growing nicely? Let’s take another side view to explain it to you. On this side view, we have drawn the various structures inside the mouth with black lines. The focus is on the red thing in the middle, it is the “soft palate”. Let’s look at the top side of this picture, this time the red soft palate and the back of the black line is tightly together. So the black arrow can not run out, only “obediently” into the mouth inside. However, if we look at the picture below, the red soft palate is “lazily” hanging there, not attached to the black line behind it, so the black arrow goes out from the top of the soft palate and into the nose. In children with cleft palate, there are some children who cannot close the soft palate, so when they speak, there is a lot of “wind” coming out of the nose, which makes them sound nasal and unclear. Medically, we call this problem “palatopharyngeal insufficiency”. It is like saying that if the roof is not closed tightly, water will leak on a rainy day; once the soft palate is not closed properly, the child’s speech will leak air and wind, and the airflow needed to speak with the mouth is not enough, so he or she will not be able to speak clearly. After cleft palate surgery, there are usually two conditions that cause incomplete palatopharyngeal closure: one is that the soft palate is not long enough, and the other is that the soft palate cannot be lifted, often accompanied by a wide pharyngeal cavity. To solve this palatopharyngeal closure problem, one needs to lengthen the soft palate or restore the function of the soft palate, both of which can reduce the pharyngeal cavity at the same time. Depending on the results of the specific examination, we can choose between simple soft palate lengthening, palatopharyngeal flap pharyngoplasty or posterior pharyngeal wall flap pharyngoplasty. Simple soft palate lengthening is equivalent to a new cleft palate revision, in which the connection between the two sides of the palatine sail raphe is examined and reconstructed, and the soft palate is lengthened with a crossed tissue flap technique, so that the soft palate can be lengthened and functionally restored at the same time; palatopharyngeal flap pharyngoplasty, in which the muscle tissue flaps on both sides of the pharyngeal cavity are transferred to the posterior pharyngeal wall, leaving only a small hole for ventilation in the center of the pharynx. In this way, when speaking, the soft palate can be closed by gently lifting upwards, so that there is no more air leakage; and posterior pharyngeal flap pharyngoplasty is to lift up the muscle tissue flap of the posterior pharyngeal wall and put it on top of the soft palate, connecting the soft palate and the posterior pharyngeal wall through the posterior pharyngeal flap, leaving only ventilation holes on both sides of the throat, so that palatopharyngeal closure can be achieved by a small muscle contraction when speaking. All three methods have certain indications, and the specific method to be used depends on the examination and judgment of the phonetician, in addition to the physical examination of the patient by the surgeon. Lastly, we need to remind you that in fact, pronunciation surgery itself is not magical, and it is not that after the surgery, the speech will be immediately better. Just like when we learn English, there is no surgery that can help us achieve the “London sound” quickly. Pronunciation surgery only provides the patient with a perfect anatomical structure, but after the surgery, we need to continue the speech training to achieve a more satisfactory speech state.