The velopharyngeal mechanism serves to control specific aero-acoustic aspects of speech production that are critical for perceptually acceptable speech. It is important that the form and function of the velopharyngeal mechanism be considered in the context of basic principles related to how velopharyngeal function is essential for affecting these speech phenomena. The structural abnormalities that are characteristic of a cleft palate can have a significant effect on velopharyngeal function and, in turn, can have a negative impact on early speech development and later articulation and resonance. This chapter will review the gross anatomy, musculature, and neuroanatomy of the normal velopharyngeal mechanism, and the anatomic abnormalities that are typical of the cleft palate velopharyngeal mechanism. Physiologic and kinematic phenomena associated with velopharyngeal function will be highlighted. The various structural differences that are inherent to a repaired cleft palate will be presented, as well as how these differences can be manifested as deficiencies that can result in disordered speech.