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Houston Cranio Facial

Velopharyngeal Insufficiency

What is velopharyngeal insufficiency?

Velopharyngeal insufficiency is a poor closure of the velopharyngeal valve causing abnormal speech. The velum (or velo) describes the soft palate or roof of your mouth. The pharynx (or pharyngeal) is the area behind the soft palate. This means that when this area does not close properly air, liquids, and food can pass into the nasal pharynx or nose. When air escapes the volume and sounds produced while speaking are not normal. Volume and projection of speech decreases along with a nasal sound of certain letters or words. There are two types of palates that lead to VPI; cleft or submucous palate and velocardiofacial syndrome.

How is VPI evaluated and diagnosed?

Typically a speech and language pathologist will evaluate a person’s speech pattern to determine the abnormal speech. If the patient does not improve with therapy then a test can be performed to confirm the anatomical function of the velopharyngeal valve. The most common test performed is a video endoscopy where a small camera is inserted into the nasal passage to view the function of the valve from above the roof of the mouth. The second test that is used is to take an x-ray while the patient swallows a special liquid that shows up on x-ray film. This test is less commonly used since it provides less information about the valve function.

What is the treatment of VPI?

If speech therapy does not work and the abnormality is more structural in nature then surgery is an option. Surgery is used to narrow the gap that does not close in the velopharyngeal valve. Our experienced craniofacial plastic surgeon accomplishes this by taking tissue from the back of the throat and using it to make the valve smaller.