Velopharyngeal Dysfunction

What Is Velopharyngeal Dysfunction (VPD)?

When we talk, we send a stream of air through our oral cavity: the mouth, teeth, gums, roof of the mouth, floor of the mouth (under the tongue), and cheeks. This creates the sounds that come out of our mouths.

Velopharyngeal dysfunction (VPD) is when sound and air leaks into the nose during speech. It's also called velopharyngeal insufficiency or incompetence (VPI).

What Causes Velopharyngeal Dysfunction?

Different things can cause velopharyngeal (vee-low-fair-en-JEE-ul) dysfunction, including:

• history of cleft palate
• submucous cleft palate
• 22q deletion syndrome (DiGeorge syndrome)
• problems with the palate or throat
• adenoidectomy
• traumatic brain injury or other neurological disorders

What Are the Signs & Symptoms of Velopharyngeal Dysfunction?

Depending on how severe it is, velopharyngeal dysfunction can affect speech in various ways. Children with VPD might have these signs:

• hypernasality ("nasal sounding" speech)
• speech sound errors
• nasal air emissions (air leaking through the nose during speech)
• weak pressure on some speech sounds
• speech that's hard for others to understand

Kids with VPD also might have food and/or liquid leak through their nose when they eat or drink.

How Is Velopharyngeal Dysfunction Diagnosed?

A child with signs of VPD should go to a specialized VPD team or a cleft and craniofacial clinic for an evaluation.

During the evaluation, the family meets with several specialists, such as an ENT (ear, nose, and throat doctor), plastic surgeon, and nurses. They will get the child's medical history and do an exam. A speech-language pathologist will assess the child's speech.

The team may request a nasopharyngoscopy or videofluoroscopy. These help them get a better look at the "leak" in the back of the throat that's letting air and sound escape through the nose during speech. The results help with the diagnosis of VPD and treatment planning. Both procedures are quick and the team will discuss them with you (and your child) before getting started.

How Is Velopharyngeal Dysfunction Treated?

Speech-language therapy can help correct any abnormal speech sound errors from velopharyngeal dysfunction. But it's not used alone to treat VPD.

Kids often need other treatments, such as:

Surgical Treatment of VPD

The goal of surgery is to repair palate problems so that sound and air go through the mouth during speech. There are a few options to fix VPD. Three common ones are:

• Posterior pharyngeal flap (PPF): The surgeon takes a flap of tissue from the back of the throat and attaches it to the soft palate. This flap forms a "bridge" to close the gap letting air and sound leak through the nose during speech. Openings on each side of the flap let the child breathe normally through the nose.
• Sphincter pharyngoplasty: The surgeon takes a flap of tissue from behind each tonsil and connects them across the back of the throat. This makes the gap smaller.
• Conversion to Furlow palatoplasty: Depending on the type of initial cleft repair a child had, the surgeon may be able to rearrange the skin and muscle layers in the back of the throat. This can lengthen the palate and works well if a small gap is causing the VPD.

Your surgeon will talk about the different options, and suggest the best one for your child. Your child might need more tests before surgery, like a sleep study. Be sure to discuss any questions and concerns with your team.

How Do We Get an Evaluation?

Velopharyngeal dysfunction can have a huge impact on a child's life. It's not something that kids "outgrow," so it is important to get an evaluation to find the cause.

If you notice signs of VPD in your child, get an evaluation from an experienced team of providers. Even in kids with no history of cleft palate, cleft and craniofacial teams can evaluate and treat their VPD.

To find a team in your area, look online at:

• The American Cleft Palate-Craniofacial Association (ACPA)