Velopharyngeal Insufficiency

By: Dr. Mohammed A. AljodahM.B.Ch.B. MRCSEd

Definition

• VPI is the inability to achieve closure of the velopharyngeal port during sustained speech.

causes

• cleft of the secondary palate and submucous cleft palate.

• neuromuscular abnormalities.• Adenoidectomy.• congenital VPI of unknown etiology.• Pharyngomegaly .

Signs

• Hypernasality.• nasal emission. • Imprecise consonant production.• decreased vocal intensity (loudness),• short phrases

DDX

• hearing difficulties• abnormal speech habits.• psychosocial delay. • tongue restriction.

Preoperative Evaluation.

• Clinical examination:• intraoral examination will determine if an

intravelar veloplasty was performed at the time of cleft palate repair and if the levator sling is functioning appropriately.

multiview videofluoroscopyand nasopharyngoscopy

• Provides information regarding the posterior and superior movement of the velum as "M:U as the degree of medial excursion of the lateral pharyngeal walls during speech.

TREATMENT

• NON SURGICAL:• speech therapy.• prosthetic management with speech bulb or

palatal lift appliances.• posterior pharyngeal injections or implants.

speech bulb

palatal lift appliances

Surgical

1. Palatal surgery:secondary palate lengthening procedure such as a Furlow palatoplasty.

Pharyngeal Surgery

• Pharyngeal Flaps.

• Sphincter Pharyngoplasty.

Pharyngeal Flaps.

• Longitudinal incisions through the mucosa and muscle down to the fascia on each side of the posterior pharyngeal wall. Dissection is continued along the fascia. A superiorly based flap is transversely incised inferiorly and raised to a level above the palatal plane, An inferiorly based flap is incised just below the adenoid pad. The flap is usually inset with tum-back flaps on the nasal side of the uvula.

Sphincter Pharyngoplasty

• superiorly based flaps raised from the posterior tonsilar pillars, including mucosa and the palatopharyngeus muscle.

• the flaps are transposed to the midline and inset into a defect created by a transverse incision at the level of the flap base.

Complications of Pharyngeal Surgery

• Bleeding.• airway obstruction,• sleep apnea.(resolve within 5 months )• surgical revision of the flap.

THANK YOU