Nine adults underwent superiorly based pharyngeal flaps for the treatment of severe velopharyngeal insufficiency (VPI). The etiology of the VPI was failed pediatric cleft palate repair in eight and myasthenia gravis in the ninth. All patients were evaluated by a speech therapist pre-operatively. There were no significant early or late postsurgical complications. After extensive speech therapy all patients were noted subjectively and objectively to have a marked reduction in hypernasality and nasal air escape and improved speech intelligibility. The healed fibrotic flaps appeared to be adynamic and acted more as a viable midline obturator. Lateral pharyngeal wall contraction was necessary to close the lateral ports during phonation. The patient with myasthenia gravis had the least improvement presumably due to poor lateral wall mobility.