The objective of this study is to further the literature's understanding the efficacy of, and possible indications for, pharyngeal augmentation as an alternative treatment of Velopharyngeal insufficiency (VPI). Furlow palatoplasty, sphincter pharyngoplasty, and pharyngeal flaps are the surgical procedures most commonly used for treatment of VPI. Surgical manipulation, however, can alter both form and function of the posterior pharyngeal wall. In cases where palatal motion is insufficient to close the gap, but nonetheless preserved, surgery on the more static, posterior wall may preserve more palatal function, and at the same time, improve speech. Pharyngeal augmentation has been described in the literature as an alternate, less invasive, means of VPI treatment. The authors performed a 5-year retrospective chart and database review and analysis of all patients at the Portland, Oregon Shriner's Hospital who underwent pharyngeal augmentation for VPI. History of cleft palate surgery and syndromic diagnosis was reviewed. Velopharyngeal competence was compared on all patients by evaluation of pre- and post-operative speech assessments and also on all patients who underwent pre- and post-operative videonasopharyngoscopy. Surgical techniques and augmentation material utilized were reviewed. Posterior pharyngeal wall augmentation remains an alternative treatment modality in the management of VPI.