Velopharyngeal Dysfunction

Question 1

Velopharyngeal Dysfunction

Answer 1

any abnormal velopharyngeal function, regardless of cause

Question 2

Velopharyngeal insufficiency

Answer 2

VPD caused by any structural abnormality at the level of the velum or pharyngeal wall

Question 3

Velopharyngeal incompetence

Answer 3

VPD caused by impaired neuromotor control of the velum or pharyngeal wall

Question 4

Velopharyngeal mislearning

Answer 4

VPD not caused by structural or neuromotor abnormalities

Question 5

Nasal emission

Answer 5

Nasal increase in airflow, occurs mostly during the production of pressure consonants (p, b, t, d, k ,g) , fricatives (f, v, z, sh, th), and affricates (ch, j)

Question 6

Hypernasality

Answer 6

increased reverberation of nasally escaping air in a confined post-nasal space, occurs mostly during production of vowels

Question 7

Hyponasality

Answer 7

decreased reverberation of nasally escaping air in a confined post-nasal space, occurs mostly during production of vowels

Question 8

Nasal rustle/turbulence

Answer 8

Distinctive fricative sound on the voiced pressure consonants, b, d, g

Question 9

Grimace

Answer 9

aberrant facial muscle movement, produced by attempt to inhibit abnormal nasal airflow by constricting the nares

Question 10

Nasal substitution

Answer 10

VPD during production of an oral consonant with appropriately positioned articulators converts it to a nasal equivalent (b becomes m, d becomes n)

Question 11

Compensatory articulation

Answer 11

production of plosives or fricatives despite VPD by inappropriately positioned articulators, closure occurs at glottal or pharyngeal level

Question 12

Sibilant distortion

Answer 12

production of sounds s, z with incorrect tongue placement, often results in malocclusion

Question 13

Causes of VPD in cleft palate

Answer 13

• unrepaired, short, immobile (extensive scar, inadequate velar construction), palate
• palatal fistula
• midface advancement in patients with prior borderline VPD

Question 14

Causes of VPD in non-cleft palate

Answer 14

• Neuromotor impairment: congenital or acquired neuromuscular condition (TBI, Myesthenia gravis, cerebral palsy)
• underlying syndrome (velocardiofacial, VATER, Kleinfelter, Turner)
• Mislearning: phoneme-specific nasal emission
• Postadenoidectomy, tonsillar hypertrophy
• Extensive use of wind-blowing instruments

Question 15

Evaluation (timing and method)

Answer 15

2-3 years of age

• intraoral exam of occlusion (for identification)
• perceptual speech eval
• instrumental VPD assessment for quantification of size and location of port (multiview videofluoroscopy, nasometry, nasendoscopy, MRI)

Question 16

Treatment of VPD

Answer 16

• non surgical: speech therapy, prosthetic (palatal lift, obturator, lift-orator)
• surgical: minimal, circular (Furlow Z plasty), moderate circular or sagittal (pharyngeal flap), severe circular, coronal or bow tie (sphincter)

Question 17

Preoperative considerations

Answer 17

remove hypertrophied tonsils and adenoids 3 months pre op

Question 18

Sphincter pharyngoplasty

Answer 18

lateral pharyngeal wall muscle and mucosa are elevated and inset into posterior and/or lateral pharyngeal walls at the level of the proposed VP port closure

Question 19

Posterior pharyngeal flap

Answer 19

posterior pharyngeal wall (mucosa and pharyngeal constrictor muscle) is elevated and inset into the soft palate.

Question 20

Postop care considerations

Answer 20

Airway management, analgesia, assurance of adequate oral intake

Question 21

Complications

Answer 21

sleep-disordered breathing, acute OSA, dehiscence with persistent VPD, hyponasality, injury to anomalous carotid artery