ABSTRACT
Velopharyngeal closure is required for normal speech production. Incomplete velopharyngeal
closure manifests as resonance disorders and nasal air escape. Management of velopharyngeal
insufficiency requires a general knowledge of speech production as well as a more
detailed understanding of the velopharyngeal mechanism. Comprehensive evaluation by
a velopharyngeal insufficiency team includes medical assessment focusing on airway
obstructive symptoms, perceptual speech analysis, and instrumental assessment, which
is utilized to characterize the velopharyngeal gap. Options for intervention include
speech therapy, intraoral prosthetic devices, and surgery. Surgical interventions
can be categorized as palatal, palatopharyngeal, or pharyngeal procedures. The therapeutic
challenge lies in achieving velopharyngeal closure during speech production while
maintaining patency of the upper airway. We present our protocol for evaluation of
velopharyngeal function with a focus on indications for palatoplasty and pharyngoplasty.
We also discuss surgical modifications of sphincter pharyngoplasty.
KEYWORDS
Palatoplasty - cleft palate - velopharyngeal insufficiency - pharyngoplasty - review
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Kathleen C.Y SieM.D.
Associate Professor, Pediatric Otolaryngology-Head and Neck Surgery, Director, Childhood
Communication Center, Children's Hospital and Regional Medical Center, University
of Washington
W-7729, 4800 Sand Point Way NE, Seattle, WA 98105
