A comparative analysis of 275 patients who underwent palatoplasty between 1961 and 9171 is presented. Of these, 149 patients had a Langenbeck palatoplasty and 188 a V-Y pushback palatoplasty. Speech results in these patients were carefully assessed by experience speech pathologists using conversational and structured (word articulation tests) speech, manometric ratios, and radiographic evidence of palatal movement. Over all, 73% of the V-Y pushback patients attained acceptable speech compared to 56% in the Langenbeck category. Patients with clefts of the soft palate only had the highest incidence of acceptable speech (91% in Langenbeck, 81% in V-Y). In both categories the results were poorer in the more extensive clefts.