ObjectiveTo assess the quality of nasopharyngoscopy video recordings used for velopharyngeal insufficiency (VPI) surgical planning and identify factors that limit evaluation of velopharyngeal closure.DesignProspective observational study.SettingMetropolitan-based hospitals with craniofacial clinics in the United States and Canada.ParticipantsOne-hundred and forty-two (142) patients with VPI across 10 hospitals.Assessment(s)Nasopharyngoscopy video recordings used for VPI surgical planning .Main Outcome Measure(s)Ratability of nasopharyngoscopy video recordings, with "ratable" defined as the video (1) visualized the velum, lateral pharyngeal wall, and posterior pharyngeal walls at some point during speech production and (2) contained an oral speech sample at the phrase level or above.ResultsOne-hundred and forty-two (142) nasopharyngoscopy video recordings were obtained from patients undergoing VPI evaluation, of which 59.9% (n=85) were ratable. A multilevel logistic regression model was used to identify factors that influenced the quality of nasopharyngoscopy video recordings. Factors associated with unratable nasopharyngoscopy videos were age (