This retrospective study spans the years 1988 to 2000 and looks specifically at the treatment procedures and outcomes for the correction of velopharyngeal insufficiency (VPI). Ninety-eight patients underwent preoperative assessment by speech pathologists that included perceptual speech evaluation, videofluoroscopy, and, for some, nasendoscopy. Based on this evaluation protocol, a specific surgical procedure was chosen to serve the patients' needs. The four procedures of choice were the palatal pushback with a pharyngeal flap lining, sphincter pharyngoplasty, a superiorly based obturating pharyngeal flap, and Furlow palatoplasty. The criteria for selecting these procedures are reviewed. The results revealed VPI resolution and the establishment of normal nonnasal speech in more than 95% of the 75 patients for whom outcomes were determined. This study reiterates the importance of thorough preoperative evaluation and the individualization of the secondary corrective procedure.

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Velo-cardio-facial syndrome, DiGeorge syndrome, conotruncal anomaly face syndrome, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect are all associated with hemizygosity of 22q11. While the prevalence of the deletions in these phenotypes has been studied, the frequency of deletions in patients presenting with velopharyngeal insufficiency (VPI) is unknown. We performed fluorescence in situ hybridization for locus D22S75 within the 22q11 region on 23 patients with VPI (age range 5-42 years) followed in the Craniofacial Clinic at the University of Florida. The VPI occurred either as a condition of unknown cause (n=16) or as a condition remaining following primary cleft palate surgery (n=7). Six of sixteen patients with VPI of unknown cause and one of seven with VPI following surgery had a deletion in the region. This study documents a high frequency of 22q11 deletions in those presenting with VPI unrelated to overt cleft palate surgery and suggests that deletion testing should be considered in patients with VPI.

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.