Velopharyngeal insufficiency: diagnosis and management

Abstract

Purpose of Review-Journal articles relevant to the diagnosis and treatment of velopharyngeal insufficiency (VPI) were reviewed. All articles ascertained by PubMed search were included.Recent Findings-Articles reported on the application of magnetic resonance scanning, reliability tests of the International Working Group diagnostic protocol, the use of nasometry, and techniques designed to assess the function of the velopharyngeal mechanism. Treatment papers focused on outcomes in small samples of cases and complication rates from pharyngeal flap. One paper discussed ineffective speech therapy procedures.Summary-There were relatively few papers this past year. Those that were published were hindered by small and heterogeneous sample sizes, and occasionally by inappropriate methods for assessing outcomes. None of the findings will have a major impact on the current state-of-the-art for diagnosis of VPI. The speech therapy paper has a very important message that should be taken to heart by all clinicians involved in the management of children with clefts and craniofacial disorders.

Does division of pharyngeal flap operated for correction of velopharyngeal insufficiency affects speech results?

“…Velofaringeal yetmezlik, bu ünite-nin yetersiz fonksiyonu sonucunda konuşma sırasın-da nazal boşluğa hava kaçışı ve hipernazal konuşma bozukluğu ile karakterize bir klinik durumdur (15) . Damak yarığı onarımı sonrasında hiç de nadir olmayan bir durum olup, %30'a varan oranlarda görülebilmek-tedir (16) .…”

Diagnosis and Management of Velopharyngeal Insufficiency Associated with Chromosomal Syndromes

“…A deficient seal of the velopharyngeal sphincter creates an airflow leaking into the rhinopharynx, resulting in abnormal air turbulence through the nasal cavities which can be easily perceived and is called nasal emission. Hypernasality and nasal emission are the clinical signs of velopharyngeal insufficiency (VPI) [3,4].…”

“…An enlarged adenoid pad can lead to hyponasality. Also, an allergic reaction or an inflammatory or obstructive process affecting the nasal cavities can lead to hyponasality [3][4][5].…”

“…It seems simpler to use only one term to analyze and specify the underlying pathologic mechanism according to all the pertinent clinical data. Thus, there may be VPI from different causes, including anatomic or structural, iatrogenic, articulatory or neuromuscular [3][4][5].…”

The Automatic Detection of Hypernasality in Cleft Palate Speech Based on an Improved Cepstrum Method

“…Sequence of the cleft palate treatment is a long procedure, and the initial surgery creates a functional palate [3]. If the functional palate works undesirably, the abnormal resonance still exists during speech production.…”