| Velopharyngeal insufficiency | |
|---|---|
| Other names | VPI |
| Specialty | Oral and maxillofacial surgery  |
Velopharyngeal insufficiency is a disorder of structure that causes a failure of the velum (soft palate) to close against the posterior pharyngeal wall (back wall of the throat) during speech in order to close off the nasal cavity during oral speech production. This is important because speech requires sound from the vocal folds and airflow from the lungs to be directed into the oral cavity (mouth) for the production of all speech sounds, with the exception of nasal consonants (m, n, and ng). If complete closure does not occur during speech, this can cause hypernasality (a resonance disorder) and/or audible nasal emission during speech (a speech sound disorder). In addition, there may be inadequate airflow to produce most consonants, making them sound weak or omitted.[1]
The terms "velopharyngeal insufficiency", "velopharyngeal incompetence", "velopharyngeal inadequacy", and "velopharyngeal dysfunction" have often been used interchangeably, although they do not mean the same thing. "Velopharyngeal dysfunction" now refers to abnormality of the velopharyngeal valve, regardless of cause. Velopharyngeal insufficiency includes any structural defect of the velum or mechanical interference with closure. Causes include a history of cleft palate, adenoidectomy, irregular adenoids, cervical spine anomalies, or oral/pharyngeal tumor removal.[2] In contrast, "velopharyngeal incompetence" refers to a neurogenic cause of inadequate velopharyngeal closure. Causes may include stroke, traumatic brain injury, cerebral palsy, or neuromuscular disorders.[3] It is important that the term "velopharyngeal insufficiency" is used if it is an anatomical defect and not a neurological problem.[4]
- ^ Kummer AW. (2020). Speech/Resonance Disorders and Velopharyngeal Dysfunction. In Kummer, AW. Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management, 4th Edition. Burlington, MA: Jones & Bartlett Learning.
- ^ Peter D. Witt, D’Antonio. Velopharyngeal insufficiency and secondary palatal management. Clinics in plastic surgery. 1993. Oct;20(4):707-21.
- ^ Kummer AW, Marshall J, and Wilson M. (2015). Non-cleft causes of velopharyngeal dysfunction: Implications for Treatment. International Journal of Pediatric Otorhinolaryngology, 79(3):286-95.
- ^ Wermker K, Lünenbürger H, Joos U, Kleinheinz J, Jung S et al. Results of speech improvement following simultaneous push-back together with velopharyngeal flap surgery in cleft palate patients. J Craniomaxillofac Surg. 2013 Sep 13. pii: S1010-5182(13)00219-9.