short outline of Velopharyngeal insufficiency treatment options

1. Velopharyngeal Insufficiency
By: Dr. Mohammed A. Aljodah
M.B.Ch.B. MRCSEd

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

3. causes
• cleft of the secondary palate and submucous
cleft palate.
• neuromuscular abnormalities.
• Adenoidectomy.
• congenital VPI of unknown etiology.
• Pharyngomegaly .

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

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

6. 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.

7. multiview videofluoroscopy
and 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.

10. TREATMENT
• NON SURGICAL:
• speech therapy.
• prosthetic management with speech bulb or
palatal lift appliances.
• posterior pharyngeal injections or implants.

11. speech bulb

12. palatal lift appliances

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

15. Pharyngeal Surgery
• Pharyngeal Flaps.

16. • Sphincter Pharyngoplasty.

17. 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.

18. 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.

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