Download PDF
Semin Plast Surg 2012; 26(04): 170-177
DOI: 10.1055/s-0033-1333882
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Velopharyngeal Dysfunction

Albert S. Woo
1   Cleft Palate-Craniofacial Institute and Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2013 (online)

Also available at
   Permissions and Reprints

Abstract

Velopharyngeal dysfunction (VPD) is a generic term which describes a set of disorders resulting in the leakage of air into the nasal passages during speech production. As a result, speech samples can demonstrate hypernasality, nasal emissions, and poor intelligibility. The finding of VPD can be secondary to several causes: anatomic, musculoneuronal, or behavioral/mislearning. To identify the etiology of VPD, patients must undergo a thorough velopharyngeal assessment comprised of perceptual speech evaluation and functional imaging, including video nasendoscopy and speech videofluoroscopy. These studies are then evaluated by a multidisciplinary team of specialists, who can decide on an optimal course for patient management. A treatment plan is developed and may include speech therapy, use of a prosthetic device, and/or surgical intervention. Different surgical options are discussed, including posterior pharyngeal flap, sphincter pharyngoplasty, Furlow palatoplasty, palatal re-repair, and posterior pharyngeal wall augmentation.

Keywords

velopharyngeal dysfunction - insufficiency - cleft palate - hypernasal speech
 

  • References

  • 1 Lewis JR, Andreassen ML, Leeper HA, Macrae DL, Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence. J Otolaryngol 1993; 22 (2) 113-117
    PubMedSearch in Google Scholar
  • 2 Paal S, Reulbach U, Strobel-Schwarthoff K, Nkenke E, Schuster M. Evaluation of speech disorders in children with cleft lip and palate. J Orofac Orthop 2005; 66 (4) 270-278
    CrossrefPubMedSearch in Google Scholar
  • 3 Trost-Cardamone JE. Coming to terms with VPI: a response to Loney and Bloem. Cleft Palate J 1989; 26 (1) 68-70
    PubMedSearch in Google Scholar
  • 4 Witt PD, Wahlen JC, Marsh JL, Grames LM, Pilgram TK. The effect of surgeon experience on velopharyngeal functional outcome following palatoplasty: is there a learning curve?. Plast Reconstr Surg 1998; 102 (5) 1375-1384
    CrossrefPubMedSearch in Google Scholar
  • 5 Sell D, Grunwell P, Mildinhall S , et al. Cleft lip and palate care in the United Kingdom—the Clinical Standards Advisory Group (CSAG) Study. Part 3: speech outcomes. Cleft Palate Craniofac J 2001; 38 (1) 30-37
    CrossrefPubMedSearch in Google Scholar
  • 6 Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB. Submucous cleft palate and velopharyngeal insufficiency: comparison of speech outcomes using three operative techniques by one surgeon. Cleft Palate Craniofac J 2011; 48 (5) 561-570
    CrossrefPubMedSearch in Google Scholar
  • 7 Havstam C, Lohmander A, Persson C, Dotevall H, Lith A, Lilja J. Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy. Br J Plast Surg 2005; 58 (7) 922-931
    CrossrefPubMedSearch in Google Scholar
  • 8 Sommerlad BC. Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy. Br J Plast Surg 2005; 58 (7) 932-933
    CrossrefPubMedSearch in Google Scholar
  • 9 Lipira AB, Grames LM, Molter D, Govier DP, Kane AA, Woo AS. Videofluoroscopic and nasendoscopic correlates of speech in velopharyngeal dysfunction. Cleft Palate Craniofac J 2011; 48 (5) 550-560
    CrossrefPubMedSearch in Google Scholar
  • 10 Golding-Kushner KJ, Argamaso RV, Cotton RT , et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group. Cleft Palate J 1990; 27 (4) 337-347 , discussion 347–348
    CrossrefPubMedSearch in Google Scholar
  • 11 Argamaso RV, Shprintzen RJ, Strauch B , et al. The role of lateral pharyngeal wall movement in pharyngeal flap surgery. Plast Reconstr Surg 1980; 66 (2) 214-219
    PubMedSearch in Google Scholar
  • 12 Marsh JL. The evaluation and management of velopharyngeal dysfunction. Clin Plast Surg 2004; 31 (2) 261-269
    CrossrefPubMedSearch in Google Scholar
  • 13 Gosain AK, Arneja JS. Management of the black hole in velopharyngeal incompetence: combined use of a Furlow palatoplasty and sphincter pharyngoplasty. Plast Reconstr Surg 2007; 119 (5) 1538-1545
    CrossrefPubMedSearch in Google Scholar
  • 14 Ysunza A, Pamplona C, Ramírez E, Molina F, Mendoza M, Silva A. Velopharyngeal surgery: a prospective randomized study of pharyngeal flaps and sphincter pharyngoplasties. Plast Reconstr Surg 2002; 110 (6) 1401-1407
    CrossrefPubMedSearch in Google Scholar
  • 15 Abyholm F, D'Antonio L, Davidson Ward SL , et al; VPI Surgical Group. Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1.  year postoperatively: results of a randomized trial. Cleft Palate Craniofac J 2005; 42 (5) 501-511
    CrossrefPubMedSearch in Google Scholar
  • 16 Schoenborn K. Über eine neue Methode der Staphylorrhaphie. Verh Dtsch Ges Chir 1875; 4: 235-239
    PubMedSearch in Google Scholar
  • 17 Schoenborn K. Vorstellung eines Falle von Staphyloplastik. Verh Dtsch Ges Chir 1886; 15: 57-62
    PubMedSearch in Google Scholar
  • 18 Padgett EC. The repair of cleft palates after unsuccessful operations, with special reference to cases with an extensive loss of palatal tissue. Arch Surg 1930; 20: 453-472
    CrossrefPubMedSearch in Google Scholar
  • 19 Hogan VM. A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (l.p.c.) pharyngeal flap. Cleft Palate J 1973; 10: 331-345
    PubMedSearch in Google Scholar
  • 20 Shprintzen RJ, Lewin ML, Croft CB , et al. A comprehensive study of pharyngeal flap surgery: tailor made flaps. Cleft Palate J 1979; 16 (1) 46-55
    PubMedSearch in Google Scholar
  • 21 Hynes W. Pharyngoplasty by muscle transplantation. Br J Plast Surg 1950; 3 (2) 128-135
    CrossrefPubMedSearch in Google Scholar
  • 22 Hynes W. The results of pharyngoplasty by muscle transplantation in failed cleft palate cases, with special reference to the influence of the pharynx on voice production; Hunterian lecture, 1953. Ann R Coll Surg Engl 1953; 13 (1) 17-35
    PubMedSearch in Google Scholar
  • 23 Orticochea M. Construction of a dynamic muscle sphincter in cleft palates. Plast Reconstr Surg 1968; 41 (4) 323-327
    CrossrefPubMedSearch in Google Scholar
  • 24 Jackson IT, Silverton JS. The sphincter pharyngoplasty as a secondary procedure in cleft palates. Plast Reconstr Surg 1977; 59 (4) 518-524
    CrossrefPubMedSearch in Google Scholar
  • 25 Furlow Jr LT. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg 1986; 78 (6) 724-738
    CrossrefPubMedSearch in Google Scholar
  • 26 Guneren E, Uysal OA. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg 2004; 62 (4) 446-450
    CrossrefPubMedSearch in Google Scholar
  • 27 Honjo I, Harada H, Okazaki N. Significance of levator muscle sling formation in cleft palate surgery: evaluation by electrical stimulation. Plast Reconstr Surg 1980; 65 (4) 443-446
    PubMedSearch in Google Scholar
  • 28 Hassan ME, Askar S. Does palatal muscle reconstruction affect the functional outcome of cleft palate surgery?. Plast Reconstr Surg 2007; 119 (6) 1859-1865
    PubMedSearch in Google Scholar
  • 29 Chen PK, Wu JT, Chen YR, Noordhoff MS. Correction of secondary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty. Plast Reconstr Surg 1994; 94 (7) 933-941 , discussion 942–943
    CrossrefPubMedSearch in Google Scholar
  • 30 Perkins JA, Lewis CW, Gruss JS, Eblen LE, Sie KC. Furlow palatoplasty for management of velopharyngeal insufficiency: a prospective study of 148 consecutive patients. Plast Reconstr Surg 2005; 116 (1) 72-80 , discussion 81–84
    PubMedSearch in Google Scholar
  • 31 Sie KC, Tampakopoulou DA, Sorom J, Gruss JS, Eblen LE. Results with Furlow palatoplasty in management of velopharyngeal insufficiency. Plast Reconstr Surg 2001; 108 (1) 17-25 , discussion 26–29
    CrossrefPubMedSearch in Google Scholar
  • 32 Chen PK, Wu J, Hung KF, Chen YR, Noordhoff MS. Surgical correction of submucous cleft palate with Furlow palatoplasty. Plast Reconstr Surg 1996; 97 (6) 1136-1146 , discussion 1147–1149
    CrossrefPubMedSearch in Google Scholar
  • 33 D'Antonio LL, Eichenberg BJ, Zimmerman GJ , et al. Radiographic and aerodynamic measures of velopharyngeal anatomy and function following Furlow Z-plasty. Plast Reconstr Surg 2000; 106 (3) 539-549 , discussion 550–553
    PubMedSearch in Google Scholar
  • 34 Deren O, Ayhan M, Tuncel A , et al. The correction of velopharyngeal insufficiency by Furlow palatoplasty in patients older than 3 years undergoing Veau-Wardill-Kilner palatoplasty: a prospective clinical study. Plast Reconstr Surg 2005; 116 (1) 85-93 , discussion 94–96
    CrossrefPubMedSearch in Google Scholar
  • 35 Wójcicki P, Wójcicka K. Prospective evaluation of the outcome of velopharyngeal insufficiency therapy after pharyngeal flap, a sphincter pharyngoplasty, a double Z-plasty and simultaneous Orticochea and Furlow operations. J Plast Reconstr Aesthet Surg 2011; 64 (4) 459-461
    CrossrefPubMedSearch in Google Scholar
  • 36 Dailey SA, Karnell MP, Karnell LH, Canady JW. Comparison of resonance outcomes after pharyngeal flap and Furlow double-opposing z-plasty for surgical management of velopharyngeal incompetence. Cleft Palate Craniofac J 2006; 43 (1) 38-43
    CrossrefPubMedSearch in Google Scholar
  • 37 Rottgers SA, Ford M, Cray J , et al. An algorithm for application of Furlow palatoplasty to the treatment of velocardiofacial syndrome-associated velopharyngeal insufficiency. Ann Plast Surg 2011; 66 (5) 479-484
    CrossrefPubMedSearch in Google Scholar
  • 38 Sommerlad BC, Henley M, Birch M, Harland K, Moiemen N, Boorman JG. Cleft palate re-repair—a clinical and radiographic study of 32 consecutive cases. Br J Plast Surg 1994; 47 (6) 406-410
    CrossrefPubMedSearch in Google Scholar
  • 39 Sommerlad BC, Mehendale FV, Birch MJ, Sell D, Hattee C, Harland K. Palate re-repair revisited. Cleft Palate Craniofac J 2002; 39 (3) 295-307
    CrossrefPubMedSearch in Google Scholar
  • 40 Passavant G. Über die Verbesserung der Sprache nach der Uranoplastik. Deutch Geselschaft Chirurgie 1879; 23: 771-780
    PubMedSearch in Google Scholar
  • 41 Gersuny R. Über eine subcutane Prosthese. Zeitschrift fur Heilkunde 1900; 21: 199-204
    PubMedSearch in Google Scholar
  • 42 Eckstein H. Hartparaffininjecktionen in der hintere Rachenwand bei angeborenen und etwarbenen Gaumendefekten. Deutsch med. Wochenschrift 1922; 1: 1186-1187
    PubMedSearch in Google Scholar
  • 43 Hollweg E, Perthes G. Beitrag zur Behandlung von Gaumenspalten. Tübingen: Pietzcker; 1912
    Search in Google Scholar
  • 44 Bentley FH, Watkins II. Speech after repair of cleft palate. Lancet 1947; 2 (6485) 862-865
    PubMedSearch in Google Scholar
  • 45 Denny AD, Marks SM, Oliff-Carneol S. Correction of velopharyngeal insufficiency by pharyngeal augmentation using autologous cartilage: a preliminary report. Cleft Palate Craniofac J 1993; 30: 46-54
    CrossrefPubMedSearch in Google Scholar
  • 46 von Gaza WV. Transplanting of free fatty tissue in the retropharyngeal area in cases of cleft palate. Paper presented at: German Surgical Society, April 9, 1926; Berlin, Germany
    PubMed
  • 47 Halle H. Gaumennaht und gaumenplastik. Ztschr Hals, Nasen-U. Ohrenheilk 1925; 12: 377-389
    PubMedSearch in Google Scholar
  • 48 Blocksma R. Correction of velopharyngeal insufficiency by Silastic pharyngeal implant. Plast Reconstr Surg 1963; 31: 268-274
    CrossrefPubMedSearch in Google Scholar
  • 49 Blocksma R, Braley S. The silicones in plastic surgery. Plast Reconstr Surg 1965; 35: 366-370
    PubMedSearch in Google Scholar
  • 50 Lewy R, Cole R, Wepman J. Teflon injection in the correction of velopharyngeal insufficiency. Ann Otol Rhinol Laryngol 1965; 74 (3) 874-879
    PubMedSearch in Google Scholar
  • 51 Wolford LM, Oelschlaeger M, Deal R. Proplast as a pharyngeal wall implant to correct velopharyngeal insufficiency. Cleft Palate J 1989; 26 (2) 119-126 , discussion 126–128
    PubMedSearch in Google Scholar