The purpose of this investigation was to determine the effect of anomalies of the upper cervical vertebrae on the antero-posterior diameter of the nasopharyngeal port. The osseous nasopharyngeal depth was determined from lateral roentgencephalograms for 38 congenital palatopharyngeal incompetent (CPI) patients with anomalies of the upper cervical vertebrae, 38 CPI patients without cervical anomalies, and 76 matched control subjects. Comparison of these measures between groups revealed a significantly greater osseous nasopharyngeal depth in those CPI patients with cervical anomalies. No significant difference existed between the CPI patients without cervical anomalies and their matched controls or between the two matched control groups.