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.
