Velopharyngeal incompetence occurs in approximately 25% of cases after primary palatoplasty. There is controversy regarding the best method of surgical management of velopharyngeal incompetence. Between 1986 and 1993, 13 children with velopharyngeal incompetence after primary palatoplasty underwent Furlow Z-plasty repair. All children were assessed by a speech therapist and with videofluoroscopy pre- and postoperatively. The Furlow Z-plasty was performed at a mean age of 7.8 years (range, 4-12 years). Eleven children achieved normal resonance, and all 13 demonstrated improved velopharyngeal function on videofluoroscopy. The Furlow Z-plasty is effective treatment for children with velopharyngeal incompetence.