Assessment and Management of Velopharyngeal Insufficiency

The inability to communicate effectively can result in significant socialdevelopmental compromise in children. Children who suffer from velopharyngeal insufficiency (VPI) will suffer from loss of volume and intelligibility of their speech, which is resultantly hypernasal.

Most causes of VPI in children are anatomic or neuromuscular. A history of cleft palate either before or after repair is the most common cause of VPI. The importance of syndrome recognition in patients with VPI is critical, as this population may be at particular risk for postoperative airway obstruction, respond less reliably to surgical correction, and require more aggressive adjunctive speech therapy.

The evaluation of VPI consists of a thorough history, physical examination, velopharyngeal assessment, and most importantly, a speech resonance analysis. A multidisciplinary approach consisting of an initial assessment conducted by an otolaryngologist and a speech pathologist is most effective for the diagnosis and management of VPI. Also, directed speech therapy remains a central component in the primary or adjunctive treatment of children with VPI.

In general, surgical procedures employed to treat VPI can be classified as palatal, palatopharyngeal, or pharyngeal. Outcomes after VPI surgery are probably dependent on a multitude of factors, including severity of preoperative VPI, gap size, presence or absence of comorbidities or syndromes and surgeon comfort.

Keywords: Velopharyngeal insufficiency, velopharyngeal dysfunction, cleft palate, submucous cleft palate, occult submucous cleft palate, hypernasal speech, speech therapy, 22q11 deletion, perceptual speech evaluation, nasoendoscopy, sphincter pharyngoplasty, pharyngeal flap.