ObjectiveAssess the patient compliance rate for nasopharyngoscopy as documented in clinical reports.DesignCross-sectional.SettingThirteen cleft teams in North America.PatientsPatients aged 3 to 21 years old with a repaired cleft palate.InterventionsNasopharyngoscopy.Main Outcome MeasurePatient compliance rate for nasopharyngoscopy.ResultsPatient compliance was documented in 128 of 158 reports (81%). Of the 128 reports, patient compliance was reported as "good/excellent" in 65% (n = 83), "marginal/fair" across 10% (n = 13), "poor" in 16% (n = 20), and "other" in 9% (n = 12). Patients with "poor" compliance had lower rates of documented imaging ratings, however 55% (n = 11) of reports included a surgical recommendation.ConclusionsAmong children completing nasopharyngoscopy for velopharyngeal insufficiency surgery planning, at least one-fourth of reports indicate significant compliance issues that limits velopharyngeal port imaging. These findings suggest that some cleft teams and surgeons may be proceeding with surgical management of velopharyngeal insufficiency without adequate visualization or ratings of velopharyngeal anatomy.