The previously reported cases of velopharyngeal insufficiency and dysphagia [3,5], and the manifestations of our patient may be related to the haploinsufficiency of HOXA3 and/or HOXA5 as already stated by Devriendt [5]; alternatively in our case, they may be explained by the additive effects of haploinsufficiency and mild prematurity. This evidence concerns the gene HOXA3 and Velopharyngeal insufficiency.