Velopharyngeal Insufficiency

Excerpt

Velopharyngeal insufficiency (VPI) is a disorder of the velopharyngeal sphincter or valve, which separates the nasal and oral cavities during speech, swallowing, vomiting, blowing, and sucking. When the soft palate and pharyngeal walls cannot form an effective seal, an abnormal connection between the nasal and oral cavities leads to hypernasal speech, increased nasal resonance, regurgitation, nasal emission, and decreased intraoral pressure during speech. The overall result is reduced speech intelligibility and significant functional and social impairment. Diagnosis and treatment require a multidisciplinary approach centered around speech-language pathology, otolaryngology, and plastic surgery. VPI is the favored nomenclature, as it denotes a deficit of the velopharyngeal closure without implying a specific cause. It can be further subdivided into VPI, incompetence, and mislearning, which provides additional information on the causation.VPI indicates structural defects, incompetency results from neurologic dysfunction, and mislearning arises from acquired articulation errors.