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Correct velopharyngeal function is necessary in order to speak and swallow correctly. The soft portion of the roof of the mouth (called the “soft palate” or the “velum”) needs to make contact with the back wall of the throat (called the “pharynx”) to separate the mouth from the nose. Velopharyngeal insufficiency (VPI) or dysfunction (VPD) occurs when the mouth and nasal cavity are not separated appropriately. It can occur because of a structural problem or because of a learned/functional problem. VPI is often associated with cleft palate but can also be present in patients with no history of a cleft. Patients with VPI may experience any or all of the following symptoms:

  • “Nasal” sounding speech/hypernasality
  • Excessive airflow out the nose while talking
  • Articulation disorders
  • Food or liquid in the nose while swallowing

Diagnosis of VPI/VPD

Patients with VPI are evaluated by a plastic and reconstructive surgeon, who performs a clinical exam, and a speech pathologist, who performs a speech exam. These specialists will diagnose VPD and determine if it is due to a structural problem requiring medical intervention or a learned/functional problem requiring speech therapy. Based on the results of the speech exam, a test known as video nasopharyngoscopy (often called a “scope”) may be recommended. Some patients may be referred for cytogenetics testing, as VPD is associated with some genetic disorders. Based on the lab results, an appointment with a medical genetics counselor may be recommended.

Video Nasopharyngoscopy

If a nasopharyngoscopy is recommended for you or your child, it will be performed by the clinic speech pathologist. There are no special feeding instructions prior to the test and children ages four and up can usually tolerate the exam with the use of a topical anesthetic. To perform the exam, a flexible scope is inserted into the patient’s nose that has a camera attachment. The speech pathologist will ask the patient to repeat certain words or phrases while the camera takes a video of the intraoral structures.
Following the exam, the speech pathologist and the plastic surgeon will review the video together to determine if medical intervention is necessary and, if so, what type.

Treatment of VPI/VPD

Based on the results of the clinical exam, the speech evaluation, and the nasopharyngoscopy, the patient may be diagnosed with VPD. Most cases of VPD require surgical intervention to correct hypernasal speech or excessive air leakage out the nose while talking. Your surgeon will determine if you or your child is a candidate for a surgery and will determine which surgical procedure can provide the best outcome. Often speech therapy is also needed. Your speech pathologist will help clarify which aspects of speech will improve with surgical intervention and which aspects will improve with speech therapy.