A review of the evaluation and management of velopharyngeal insufficiency in children

Otolaryngol Clin North Am. 2012 Jun;45(3):653-69, viii. doi: 10.1016/j.otc.2012.03.005.


This article highlights the most common causes of velopharyngeal insufficiency (VPI), and discusses routine evaluation and treatment algorithms for the management of VPI in children. VPI is a multifactorial condition that occurs commonly in syndromic and non-syndromic children. The most common features of VPI are audible hypernasal speech, facial grimacing, decreased speech intelligibility, nasal regurgitation, and nasal emission from failure to produce oronasal separation. Work-up of VPI typically involves radiologic and endoscopic testing performed with the assistance of a speech-language pathologist. Management of VPI involves initial speech therapy followed by operative repair with sphincter or pharyngeal flap pharyngoplasty, if needed.

Publication types

  • Review
  • Video-Audio Media

MeSH terms

  • Cephalometry
  • Child
  • Cleft Palate / complications
  • DiGeorge Syndrome / complications
  • Endoscopy
  • Fluoroscopy
  • Humans
  • Magnetic Resonance Imaging
  • Medical History Taking
  • Mobius Syndrome / complications
  • Muscular Dystrophies / complications
  • Myasthenia Gravis / complications
  • Nasal Cavity
  • Nervous System Diseases / complications
  • Otorhinolaryngologic Surgical Procedures
  • Palatal Muscles / pathology
  • Palatal Muscles / physiopathology
  • Palate, Soft / abnormalities
  • Palate, Soft / pathology
  • Palate, Soft / physiopathology
  • Physical Examination
  • Speech
  • Speech Production Measurement
  • Velopharyngeal Insufficiency / diagnosis*
  • Velopharyngeal Insufficiency / etiology
  • Velopharyngeal Insufficiency / therapy*
  • Video Recording