[The primary treatment of velar, palatal and vomer malformations as a prerequisite for normal speech development]

In this article the embryology, morphology, pathophysiology, and treatment of the cleft malformation of the hard, the soft palate, and the vomer are described. A therapy is suggested, which minimizes the risk that these children are suffering from an impaired development of speech. Therefore, it is necessary: 1. to recognize the full extent of the malformation, 2. to close the cleft before the development of hearing and speech is finished as these 2 abilities are fundamental milestones of a normal psychosocial development. 3. Nearly normal anatomical and functional structures are to be achieved with the surgical treatment. Therefore the construction of 2 nasal floors, the correct adaptation of the vomer to the palatal plates, and the intravelar veloplasty with the preparation of the aponeurosis are most important determinants. This treatment can avoid secondary operations to improve the results of hearing and speech.