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Velopharyngeal insufficiency (VPI) occurs when the back part of the roof of the mouth (soft palate) and the pharynx (throat) don’t work together to make a good seal when your child is talking. This is often caused by a soft palate that is too short or muscles of the palate that do not work well. Air leaks through the nose and gives their speech a nasal quality. It's often hard to understand a child with VPI, and the child must work very hard to speak and be understood.
There are several conditions that can cause VPI. The following are some of the conditions that can cause VPI:
The most common cause of VPI is a cleft palate or submucosal cleft palate (cleft covered by the lining or mucous membrane of the roof of the mouth). About10 to 40% of children who have a cleft palate with or without a cleft lip will have persistent VPI after their cleft palate repair. About 25% of children with a submucosal cleft palate will also have VPI.
Velar dysplasia can be a cause of VPI. Velar dysplasia refers to an abnormality in the growth or development of the velum. The velum is the soft flexible area located toward the back of the roof of the mouth. VPI is common in many craniofacial syndromes, particularly in hemifacial microsomia and related conditions. Related conditions include Goldenhar syndrome, oculo-auriculo-vertebral (OAV) spectrum and facio-auriculo-vertebral (FAV) spectrum.
Some patients with craniofacial conditions have a cervical spine (neck bones) that curves backward, causing their throat to be abnormally deep. When this occurs, the velum may not be long enough to contact the back wall of the throat during speech production and cause velopharyngeal insufficiency. Some conditions, such as Klippel–Feil syndrome and Down syndrome, are also associated with cervical spine anomalies that can also cause a deep pharynx.
Sometimes VPI develops after an adenoidectomy. An adenoidectomy is a surgical procedure to remove adenoids or lymphoid tissue in the back of the nose.
A child’s tonsils can become so big that they intrude into the throat. Tonsils are lymphoid tissue that are located on both sides of the back of the throat. They can restrict the movement of the side walls of the throat and prevent the velum from achieving an adequate velopharyngeal seal during speech.
Surgical removal of tumors in the mouth can affect velopharyngeal closure.
VPI is diagnosed during a thorough evaluation at our VPI Clinic. A typical visit at our VPI clinic includes the following:
VPI evaluation results are shared with the parent/caregiver and child (if developmentally appropriate) at the end of the visit. A longer report is sent in the mail within one to two weeks of the visit. If needed, the team speech-language pathologist is available to discuss the results of the evaluation with your child’s home speech-language pathologist.
Testing will take about one hour. Many caregivers have questions about whether their child will tolerate the endoscopy portion of the VPI evaluation. Our team makes a significant effort to ensure that this part of the evaluation is as comfortable as possible for your child. Numbing medicine is sprayed inside the nose before the evaluation to help decrease any discomfort.
The endoscope is a small scope designed for use with children. This portion of the visit may be uncomfortable, but will not be painful. It often lasts just a few minutes. Most children do cry some. This is normal and expected.
If you feel that your child will not tolerate this procedure well, please contact our scheduler in advance. We can connect you and your child to a child life specialist who can provide suggestions to make this procedure easier.
We have extensive experience performing tests used to diagnose VPI and have excellent reliability. We use a multidisciplinary approach to evaluate, diagnose and treat your child. We use equipment that is designed for children, which helps to minimize discomfort. Our care team members only work with children and understand how to meet the unique needs of children.
Treatment depends on your child’s condition. Your child’s treatment may include any of the following:
Our multidisciplinary team works together to understand the cause of your child’s speech difficulties and provide recommendations to improve your child’s ability to communicate and be understood. Both the speech-language therapist and the surgeon who perform evaluations and treatment are trained in and focused on pediatric care. We have state-of-the-art equipment, which enables us to provide high-quality, comprehensive care to your child.
Certified Pediatric Nurse Practitioner