Surgical and prosthetic interventions are effective means of managing cleft palate and velopharyngeal dysfunction. Most patients are managed surgically because usually there is life-long benefit from that type of intervention and an operation does not require continued cooperation from the patient. In selected cases, prosthetic intervention is preferred. Over the past century, the efficacy of such interventions has increased markedly. Not all of the factors responsible for these improved results are understood. Disagreement among care providers persists regarding the specific criteria for intervention, the use of ancillary tools beyond perceptual speech evaluation for both pre-intervention and postintervention assessments, the technical details of intervention, and the ideal age for intervention. In spite of general success of interventions for cleft palate and velopharyngeal dysfunction, much fertile ground remains to be tilled and harvested by current and future students of the problem.