velopharyngeal insufficiency

Velopharyngeal Insufficiency 

Definition

Velopharyngeal insufficiency is the improper closing of the velopharyngeal sphincter (soft palate muscle) during speech characterized by an acute nasal quality of the voice.

Description

At the back of the mouth is a circle of structures that include the tonsils, the tongue, and the palate. During speech, this apparatus must close off the nose for proper articulation of the explosive consonants "p," "b," "g," "t," and "d." If it does not close, there is a snort sound produced through the nose. Improper function of this structure also produces a nasal tone to the voice.

Causes and symptoms

There are three main causes for this defect:

• Cleft palate is a congenital condition, producing a defect in the palate that allows air to escape upward during speech.
• If tonsil and adenoid surgery is done improperly, velopharyngeal insufficiency may result. The occurrence rate is approximately one in every 2,000-3,000 tonsillectomies.
• Nerve or muscle disease may paralyze the muscles that operate the velopharyngeal sphincter.

The primary symptom is the speech impediment. Some people develop a change in their speaking pattern or a series of facial grimaces to try to overcome the difficulty. If the condition is acute, regurgitation through the nose may occur.

Diagnosis

Examination of the velopharyngeal sphincter through ultrasound scans, fiber-optic nasopharyngoscopy, and videofluoroscopy will reveal the extent of velopharyngeal insufficiency. Speech and velopharyngeal sphincter movement are compared to make the diagnosis.

Treatment

Velopharyngeal insufficiency is treated with a combination of surgery and speech therapy. There are several surgical procedures that can be performed to correct the physical malfunction. They include:

• Pharyngeal flap procedure that moves the skin flap from the pharynx to the soft palate.
• Palatal push-back that separates the hard and soft palate in order to lengthen the soft palate.
• Pharyngoplasty that lengthens the soft palate by turning the pharyngeal skin flaps.
• Augmentation pharyngoplasty that inserts an implant into the pharyngeal wall to enlarge it, thus narrowing the velopharyngeal opening.
• Velopharyngeal sphincter reconstruction.

Prognosis

The combination of surgery to correct the insufficiency and speech therapy to retrain the voice successfully alleviate velopharyngeal insufficiency.

Key terms

Adenoids — Lymph glands just above the tonsils and the palate.

Cleft palate — Congenital defect marked by a split in the roof of the mouth.

Nasopharyngoscopy — A diagnostic procedure that examines the nasal passageways and pharynx with an instrument outfitted with an optical system.

Pharynx — A canal located between the mouth cavity and the esophagus.

Tonsillectomy — Surgical removal of the tonsils.

Tonsils — Lymph glands in the throat, just behind the back teeth.

Resources

Periodicals

Huang M. H., S. T. Lee, and K. Rajendran. "Anatomic Basis of Cleft Palate and Velopharyngeal Surgery: Implications from a Fresh Cadaveric Study." Plastic & Reconstructive Surgery 101 (Mar. 1998): 613-627.

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insufficiency /in·suf·fi·cien·cy/ (-sah-fish´in-se) inability to perform properly an allotted function.

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adrenal insufficiency 

1. hypoadrenalism; abnormally diminished activity of the adrenal gland.

2. adrenocortical i.

adrenocortical insufficiency  abnormally diminished secretion of corticosteroids by the adrenal cortex, as in Addison's disease.

aortic insufficiency  defective functioning of the aortic valve, with incomplete closure resulting in aortic regurgitation.

cardiac insufficiency  heart failure.

coronary insufficiency  decrease in flow of blood through the coronary blood vessels.

insufficiency of the externi  deficient power in the externi muscles of the eye, resulting in esophoria.

ileocecal insufficiency  inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

insufficiency of the interni  deficient power in the interni muscles of the eye, resulting in exophoria.

mitral insufficiency  defective functioning of the mitral valve, with incomplete closure causing mitral regurgitation.

pulmonary insufficiency  defective functioning of the pulmonary valve, with incomplete closure causing pulmonic regurgitation.

thyroid insufficiency  hypothyroidism.

tricuspid insufficiency  defective functioning of the tricuspid valve, with incomplete closure causing tricuspid regurgitation; it is usually secondary to systolic overload.

valvular insufficiency 

1. dysfunction of a cardiac valve, with incomplete closure resulting in valvular regurgitation; named for the valve involved.

2. venous i.

velopharyngeal insufficiency  failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective speech.

venous insufficiency  inadequacy of the venous valves with impairment of venous drainage, resulting in edema.

vertebrobasilar insufficiency  transient ischemia of the brain stem and cerebellum due to stenosis of the vertebral or basilar artery.

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velopharyngeal insufficiency

n.

An anatomical deficiency in the soft palate or superior constrictor muscle resulting in the inability to achieve velopharyngeal closure and often resulting in defective speech.

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velopharyngeal insufficiency,

an abnormal condition resulting from a congenital defect in the structure of the velopharyngeal sphincter: Closure of the oral cavity beneath the nasal passages is not complete, as seen in cleft palate. Food may be regurgitated through the nose, and speech is impaired. Surgical correction is usually successful.

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insufficiency [in″sŭ-fish´en-se]

inability to perform properly an allotted function; called also incompetence.

adrenal insufficiency abnormally diminished activity of the adrenal gland; called also hypoadrenalism.

adrenocortical insufficiency abnormally diminished secretion of corticosteroids by the adrenal cortex; see also addison's disease. Called also hypoadrenocorticism and hypocorticism.

aortic insufficiency inadequate closure of the aortic valve, permitting aortic regurgitation.

coronary insufficiency decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also myocardial ischemia.

ileocecal insufficiency inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

mitral insufficiency inadequate closure of the mitral valve, permitting mitral regurgitation.

placental insufficiency dysfunction of the placenta, with reduction in the area of exchange of nutrients; it often leads to fetal growth retardation.

pulmonary insufficiency

1. pulmonary valve insufficiency.

2. respiratory insufficiency.

pulmonary valve insufficiency inadequate closure of the pulmonary valve, permitting pulmonic regurgitation.

respiratory insufficiency see respiratory insufficiency.

thyroid insufficiency hypothyroidism.

tricuspid insufficiency incomplete closure of the tricuspid valve, resulting in tricuspid regurgitation.

valvular insufficiency failure of a cardiac valve to close perfectly, causing valvular regurgitation; see also aortic, mitral, pulmonary, and tricuspid insufficiency.

velopharyngeal insufficiency inadequate velopharyngeal closure, due to a condition such as cleft palate or muscular dysfunction, resulting in defective speech.

venous insufficiency inadequacy of the venous valves and impairment of venous return from the lower limbs (venous stasis), often with edema and sometimes with stasis ulcers at the ankle.

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insufficiency

inability to perform properly an allotted function.

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adrenal insufficiency

hypoadrenalism.

aortic insufficiency

inadequacy of the aortic valve, permitting blood to flow back into the left ventricle of the heart.

cardiac insufficiency

inability of the heart to perform its function properly; heart failure.

coronary insufficiency

decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also ischemic myocardial necrosis.

hepatic insufficiency

inadequate liver function, short of hepatic failure.

ileocecal insufficiency

inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

pulmonary insufficiency

insufficiency of the pulmonary valve, permitting blood to flow into the right ventricle of the heart.

respiratory insufficiency

a condition in which respiratory function is inadequate to meet the body's needs when increased physical activity places extra demands on it. See also respiratory insufficiency.

thyroid insufficiency

hypothyroidism.

valvular insufficiency

failure of a cardiac valve to close perfectly, causing the blood to flow back through the orifice (valvular regurgitation); named, according to the valve affected, aortic, mitral, pulmonary or tricuspid insufficiency.

velopharyngeal insufficiency

failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective swallowing with regurgitation through the nose.

venous insufficiency

inadequacy of the venous valves with impairment of venous drainage, resulting in edema.