Velopharyngeal Insufficiency in Children

Velopharyngeal insufficiency (VPI) is the incomplete closure of the velopharyngeal valve during articulation and may be during feeding. The patients presented with hypernasal speech which results in difficult communication with its negative effects on the social life of the family. The problem has many causes that include structural defects either in palatal or in pharyngeal muscles. For better understanding of the underlying cause, good anatomical knowledge should be acquainted. Assessment of patients includes otolaryngologic examination, auditory perceptual assessment, nasometric assessment, and radiologic evaluation. However, flexible nasopharyngoscopy is very important to detect the degree and type of velopharyngeal closure pattern. The condition should be managed through a team approach that includes an otolaryngologist, a speech and language pathologist, an audiologist, a radiologist, an orthodontist, a pediatrician, and a psychologist. Speech therapy can be used for patients with small velopharyngeal gap and in postoperative patients where functional residual VPI is present. Orthodontic treatment with palatal obturator or speech aid prostheses is used for children with VPI who are not surgical candidates for palatal reconstruction, or who have had less than optimal surgical results. Surgical intervention is indicated for patients with structural defects, it is either palatal or pharyngeal procedure that aiming for strengthening and/or narrowing of the velopharyngeal valve.