Velopharyngeal insufficiency

A condition affecting speech due to improper closure of the velopharyngeal sphincter

Velopharyngeal insufficiency (VPI) is a disorder characterized by the inability of the velopharyngeal sphincter to close completely during speech, resulting in hypernasal speech and nasal air emission. This condition can significantly affect speech intelligibility and is often associated with cleft palate and other craniofacial anomalies.

Anatomy and Physiology

The velopharyngeal mechanism involves the coordinated action of the soft palate (velum) and the lateral and posterior pharyngeal walls. During speech, the velum elevates and contacts the posterior pharyngeal wall, while the lateral pharyngeal walls move medially to achieve closure. This closure is essential for producing oral sounds by preventing air from escaping through the nose.

Causes

VPI can be caused by structural, neurological, or functional issues. Common causes include:

• Cleft palate: A congenital condition where there is an opening in the roof of the mouth.
• Submucous cleft palate: A less obvious form of cleft palate where the mucous membrane covers the cleft.
• Neurological disorders: Conditions such as cerebral palsy or stroke that affect muscle control.
• Surgical complications: Following adenoidectomy or other surgeries affecting the palate.

Diagnosis

Diagnosis of VPI typically involves a combination of perceptual speech assessment, nasometry, and imaging studies such as nasopharyngoscopy or videofluoroscopy. These assessments help determine the presence and extent of velopharyngeal dysfunction.

Treatment

Treatment options for VPI depend on the underlying cause and severity of the condition. They may include:

Surgical Interventions

• Pharyngeal flap surgery: A procedure where a flap of tissue from the pharynx is attached to the velum to aid closure.

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Inferior based pharyngeal flap

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Superior based pharyngeal flap

• Sphincteroplasty: A surgery that narrows the pharyngeal opening by rearranging the muscles.

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Sphincteroplasty

• Augmentation procedures: Involves injecting or implanting materials to bulk up the posterior pharyngeal wall.

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Augmentation

Speech Therapy

Speech therapy is often used in conjunction with surgical treatment to improve articulation and reduce nasal emission. Techniques focus on strengthening the muscles involved in velopharyngeal closure and improving speech patterns.

Prognosis

The prognosis for individuals with VPI varies depending on the cause and treatment. Many patients experience significant improvement in speech following appropriate surgical and therapeutic interventions.

Related pages

• Cleft lip and palate
• Speech disorder
• Craniofacial abnormalities

References

• Kummer, A. W. (2008). Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Cengage Learning.
• Peterson-Falzone, S. J., Hardin-Jones, M. A., & Karnell, M. P. (2010). Cleft Palate Speech. Mosby.

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  Inferior based pharyngeal flap

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  Superior based pharyngeal flap

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  Sphincterplasty

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  Velopharyngeal insufficiency