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Despite primary and secondary surgeries, persistent VPI required a speech appliance and intensive therapy to address glottal stops and pharyngeal fricatives. While therapy eliminated these errors, residual VPI continued to impact speech intelligibility. Reassessment revealed that while some\n                    <jats:italic toggle=\"yes\">misarticulations persisted<\/jats:italic>\n                    , the patient retained\n                    <jats:italic toggle=\"yes\">speech improvements from prior therapy<\/jats:italic>\n                    , allowing for\n                    <jats:italic toggle=\"yes\">partial substitutions of target sounds<\/jats:italic>\n                    . This case emphasizes the role of speech therapy in managing misarticulation despite unresolved VPI and highlights the need for ongoing multidisciplinary care.\n                  <\/jats:p>","DOI":"10.1177\/10556656251344127","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T03:18:13Z","timestamp":1748402293000},"page":"1775-1780","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-Term Management of Velopharyngeal Insufficiency and Misarticulation in Unilateral Cleft Lip and Palate: Speech Therapy Outcomes"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4060-1356","authenticated-orcid":false,"given":"Toko","family":"Hayakawa","sequence":"first","affiliation":[{"name":"Faculty of Health Science, Aichi Gakuin University, Nagoya, Japan"},{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9027-5322","authenticated-orcid":false,"given":"Tran Phuong","family":"Thao","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"},{"name":"Hanoi Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruyuki","family":"Niimi","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0011-8223","authenticated-orcid":false,"given":"Hideto","family":"Imura","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroo","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Faculty of Health Science, Aichi Gakuin University, Nagoya, Japan"},{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagana","family":"Natsume","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7872-9291","authenticated-orcid":false,"given":"Le Kha","family":"Anh","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"},{"name":"Hanoi Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagato","family":"Natsume","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Center, Aichi Gakuin University, Nagoya, Japan"},{"name":"Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrg2933"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1597\/13-121"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619896637"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2020.07.030"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2021.110738"},{"issue":"03","key":"e_1_3_2_7_2","first-page":"251","article-title":"Velopharyngeal dysfunction: a systematic review of major instrumental and auditory-perceptual assessments","volume":"17","author":"Paniagua LM","year":"2013","unstructured":"Paniagua LM, Signorini AV, da Costa SS, Collares MVM, Dornelles S. 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