Now he complained of nasal twang in his voice. This is due to velopharyngeal muscle incompetence which causes escape of air through the nose during speech. Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the pharyngoplasty surgery rearranging the pharyngeal muscles in correct position to create a dynamic sphincter. Suction test was positive indicating successful correction of velopharyngeal incompetence.