What is velopharyngeal insufficiency?
Velopharyngeal insufficiency or VPI is a medical condition in which the soft palate does not close tightly against the back of the throat (pharynx) while talking. The soft palate forms the roof of the back of the mouth. In this condition, the soft palate and the throat are unable to juxtapose, and the speech sounds with a nasal tone (hypernasality). Such speech is difficult to understand. In a normal situation, the muscles of the soft palate move up and down and touch the back of the throat during the speech. Oral consonants, such as the letters w, ü, v, and x, are pronounced by the movement of the soft palate against the throat to form a tight seal that prevents the air from escaping in the nose. It is called velopharyngeal closure. In VPI, this closure does not occur, leading to the passage of air through the nose during speech.
What causes velopharyngeal insufficiency?
Velopharyngeal insufficiency may result in conditions, such as:
- Cleft palate: It is the most common cause of a Velopharyngeal insufficiency (VPI). A cleft palate is a condition in which a child is born with a split in the roof of the mouth with or without a cleft lip. Submucosal cleft palate (when the cleft palate is covered by a layer of mucus membrane will also produce VPI).
- Adenoidectomies: The removal of the lymphoid tissue (adenoids) at the back of the mouth may cause a temporary VPI.
- Brain injury: Brain injuries due to trauma or neurological diseases may result in muscle weakness and consequently VPI.
- Velar dysplasia: Abnormalities in the development of the soft palate (velar dysplasia) may cause VPI.
- Cervical spine abnormalities: Certain medical conditions, such as Down syndrome, may be associated with abnormal neck bones that make the throat abnormally deep, leading to VPI.
- Surgery: Surgery for the removal of certain tumors in the mouth or throat may cause VPI.
- Idiopathic: In some cases, the cause of VPI is unknown or idiopathic.
How is velopharyngeal insufficiency treated?
The velopharyngeal insufficiency treatment depends on several factors, such as the cause and severity of VPI. The treatment of this condition includes:
- Speech therapy: People with VPI do not pronounce words correctly. This may be treated with the help of speech therapy. Speech therapy is generally provided for around 6 months before the doctors go for surgical correction of VPI.
- Surgery: Surgery is the definitive treatment for VPI. The type of surgery needed by the child depends on the child’s condition and the size and shape of the velopharyngeal gap. Surgeries aim at reducing the amount of air escaping from the mouth into the nose. Some of the commonly done surgeries for VPI include:
- Furlow palatoplasty: This surgery involves the repair of the soft palate. Furrow palatoplasty surgery involves the realignment and lengthening of the muscles of the palate so that velopharyngeal closure can occur normally.
- Pharyngeal flap: In this surgery, the surgeon harvests tissue from the back of the throat and attaches it to the soft palate. This makes a physical barrier in the back of the throat.
- Sphincter pharyngoplasty: This surgery involves the formation of a ring of muscles by joining the muscles from the side of the throat to the back of the throat.
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Nam SM. Surgical Treatment of Velopharyngeal Insufficiency. Arch Craniofac Surg. 2018;19(3):163-167. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177675/