velopharyngeal insufficiency


Velopharyngeal Insufficiency

 

Definition

Velopharyngeal insufficiency is the improper closing of the velopharyngeal sphincter (soft palate muscle) during speech characterized by an acute nasal quality of the voice.

Description

At the back of the mouth is a circle of structures that include the tonsils, the tongue, and the palate. During speech, this apparatus must close off the nose for proper articulation of the explosive consonants "p," "b," "g," "t," and "d." If it does not close, there is a snort sound produced through the nose. Improper function of this structure also produces a nasal tone to the voice.

Causes and symptoms

There are three main causes for this defect:
  • Cleft palate is a congenital condition, producing a defect in the palate that allows air to escape upward during speech.
  • If tonsil and adenoid surgery is done improperly, velopharyngeal insufficiency may result. The occurrence rate is approximately one in every 2,000-3,000 tonsillectomies.
  • Nerve or muscle disease may paralyze the muscles that operate the velopharyngeal sphincter.
The primary symptom is the speech impediment. Some people develop a change in their speaking pattern or a series of facial grimaces to try to overcome the difficulty. If the condition is acute, regurgitation through the nose may occur.

Diagnosis

Examination of the velopharyngeal sphincter through ultrasound scans, fiber-optic nasopharyngoscopy, and videofluoroscopy will reveal the extent of velopharyngeal insufficiency. Speech and velopharyngeal sphincter movement are compared to make the diagnosis.

Treatment

Velopharyngeal insufficiency is treated with a combination of surgery and speech therapy. There are several surgical procedures that can be performed to correct the physical malfunction. They include:
  • Pharyngeal flap procedure that moves the skin flap from the pharynx to the soft palate.
  • Palatal push-back that separates the hard and soft palate in order to lengthen the soft palate.
  • Pharyngoplasty that lengthens the soft palate by turning the pharyngeal skin flaps.
  • Augmentation pharyngoplasty that inserts an implant into the pharyngeal wall to enlarge it, thus narrowing the velopharyngeal opening.
  • Velopharyngeal sphincter reconstruction.

Prognosis

The combination of surgery to correct the insufficiency and speech therapy to retrain the voice successfully alleviate velopharyngeal insufficiency.

Key terms

Adenoids — Lymph glands just above the tonsils and the palate.Cleft palate — Congenital defect marked by a split in the roof of the mouth.Nasopharyngoscopy — A diagnostic procedure that examines the nasal passageways and pharynx with an instrument outfitted with an optical system.Pharynx — A canal located between the mouth cavity and the esophagus.Tonsillectomy — Surgical removal of the tonsils.Tonsils — Lymph glands in the throat, just behind the back teeth.

Resources

Periodicals

Huang M. H., S. T. Lee, and K. Rajendran. "Anatomic Basis of Cleft Palate and Velopharyngeal Surgery: Implications from a Fresh Cadaveric Study." Plastic & Reconstructive Surgery 101 (Mar. 1998): 613-627.

insufficiency

 [in″sŭ-fish´en-se] inability to perform properly an allotted function; called also incompetence.adrenal insufficiency abnormally diminished activity of the adrenal gland; called also hypoadrenalism.adrenocortical insufficiency abnormally diminished secretion of corticosteroids by the adrenal cortex; see also addison's disease. Called also hypoadrenocorticism and hypocorticism.aortic insufficiency inadequate closure of the valve" >aortic valve, permitting regurgitation" >aortic regurgitation.coronary insufficiency decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also myocardial ischemia.ileocecal insufficiency inability of the valve" >ileocecal valve to prevent backflow of contents from the cecum into the ileum.mitral insufficiency inadequate closure of the valve" >mitral valve, permitting regurgitation" >mitral regurgitation.placental insufficiency dysfunction of the placenta, with reduction in the area of exchange of nutrients; it often leads to fetal growth retardation.pulmonary insufficiency 1. pulmonary valve insufficiency.2. respiratory insufficiency.pulmonary valve insufficiency inadequate closure of the valve" >pulmonary valve, permitting regurgitation" >pulmonic regurgitation.respiratory insufficiency see respiratory insufficiency.thyroid insufficiency hypothyroidism.tricuspid insufficiency incomplete closure of the valve" >tricuspid valve, resulting in regurgitation" >tricuspid regurgitation.valvular insufficiency failure of a cardiac valve to close perfectly, causing regurgitation" >valvular regurgitation; see also aortic, mitral, pulmonary, and tricuspid insufficiency.velopharyngeal insufficiency inadequate closure" >velopharyngeal closure, due to a condition such as cleft palate or muscular dysfunction, resulting in defective speech.venous insufficiency inadequacy of the venous valves and impairment of venous return from the lower limbs (stasis" >venous stasis), often with edema and sometimes with ulcers" >stasis ulcers at the ankle.

vel·o·pha·ryn·ge·al in·suf·fi·cien·cy

anatomic or functional deficiency in the soft palate or superior constrictor muscle of the pharynx, resulting in the inability to achieve velopharyngeal closure.

velopharyngeal insufficiency

n. An anatomical deficiency in the soft palate or superior constrictor muscle resulting in the inability to achieve velopharyngeal closure and often resulting in defective speech.

vel·o·pha·ryn·ge·al in·suf·fi·cien·cy

(vē'lō-făr-in'jē-ăl in'sŭ-fish'ĕn-sē) Anatomic or functional deficiency in the soft palate or superior constrictor muscle, resulting in the inability to achieve velopharyngeal closure.