velopharyngeal insufficiency

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Related to velopharyngeal insufficiency: Velopharyngeal inadequacy

Velopharyngeal Insufficiency



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


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.


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.


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.


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.



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.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


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 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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

vel·o·pha·ryn·ge·al in·suf·fi·cien·cy

anatomic or functional deficiency in the soft palate or superior constrictor muscle of the pharynx, resulting in the inability to achieve velopharyngeal closure.
Farlex Partner Medical Dictionary © Farlex 2012

velopharyngeal insufficiency

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.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

vel·o·pha·ryn·ge·al in·suf·fi·cien·cy

(vē'lō-făr-in'jē-ăl in'sŭ-fish'ĕn-sē)
Anatomic or functional deficiency in the soft palate or superior constrictor muscle, resulting in the inability to achieve velopharyngeal closure.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
References in periodicals archive ?
Outcomes of combined Furlow palatoplasty and sphincter pharyngoplasty for velopharyngeal insufficiency. Otolaryngol Head Neck Surg.
Prospective evaluation of the outcome of velopharyngeal insufficiency therapy after simultaneous double z-plasty and sphincter pharyngoplasty.
Velopharyngeal insufficiency. In: Bluestone CD, Stool SE, eds.
[6,10] In this paper, we retrospectively report the outcomes of 22 children with a high risk of velopharyngeal insufficiency who underwent surgery with a modification of the technique described by Birrell.
Mason described the prognostic indicators of velopharyngeal insufficiency following adenoidectomy.
Lateral adenoidectomy has been performed in an attempt to prevent velopharyngeal insufficiency in patients with an inadequate palate who require an adenoidectomy.
Later, Shapiro described a series of 58 patients who were treated with essentially the same superior adenoidectomy technique, and he reported excellent results, as no patient developed velopharyngeal insufficiency. [9]
Opponents of any form of adenoidectomy for patients with palatal abnormalities sometimes argue that these patients are at risk of developing velopharyngeal insufficiency at puberty.
Prospective studies that reported objective pre- and postoperative evaluations of velopharyngeal insufficiency would be helpful in further assessing the usefulness of this procedure in selected cases.