Velopharyngeal insufficiency (VPI) is the inability to achieve closure of the velopharyngeal port during speech, commonly caused by cleft palate or other structural abnormalities. Signs include hypernasality, nasal emission, and imprecise consonant production. Treatment options include speech therapy, prosthetics like palatal lifts, and surgery like pharyngeal flaps or sphincter pharyngoplasty to improve closure of the airway during speech. Surgical complications can include bleeding, airway obstruction, or sleep apnea requiring revision in some cases.

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.