Velopharyngeal dysfunction occurs when the mouth and nasal cavity are not separated appropriately during speech production. This condition is often associated with cleft palate, but sometimes it is present in children with no history of a cleft.
Correct velopharyngeal function is necessary in order to speak and swallow properly. The soft portion of the roof of the mouth (soft palate or velum) needs to make contact with the back wall of the throat (pharynx) to separate the mouth from the nose.
Velopharyngeal dysfunction can be the result of a structural problem, or it can be a learned or functional issue.
Symptoms of velopharyngeal dysfunction include:
- “Nasal-sounding" speech (hypernasality)
- Excessive airflow out of the nose while talking
- Articulation disorders
- Food or liquid in the nose while swallowing
Diagnosis of Velopharyngeal Dysfunction
Children with cleft palates should see a cleft and craniofacial team on an annual basis to be monitored for the possible development of velopharyngeal dysfunction throughout different life stages, including adenoid shrinkage, jaw growth and any orthodontia or oral surgery. However, the critical diagnosis period is usually around age 4.
Cleft and craniofacial specialists diagnose velopharyngeal dysfunction through:
- Examination. A plastic and reconstructive surgeon will perform a clinical examination, and a speech pathologist will conduct a speech exam.
- Video nasopharyngoscopy. This exam involves inserting a flexible scope with a camera attachment into the nose. The speech pathologist will ask your child to repeat certain words or phrases while the camera takes a video of the structures inside the mouth.
- Cytogenetics testing. Some patients may be referred for this type of genetic test because velopharyngeal dysfunction can be associated with some genetic disorders.
Treatment for velopharyngeal dysfunction is determined following an evaluation by a specially trained speech pathologist who can differentiate what roles speech therapy and/or surgery play in treatment. Treatment may include:
- Surgery. If velopharyngeal dysfunction is due to a structural issue, the resulting speech issues will not resolve without surgical intervention. Most cases of velopharyngeal dysfunction require surgery to correct hypernasal speech or excessive air leakage out of the nose while talking. A surgeon, with the help of a speech pathologist who specializes in velopharyngeal dysfunction, determines whether your child is a candidate for a surgical procedure. If so, the type of surgery is tailored to your child's specific needs based on the results of the nasopharyngoscopy. Medical factors are also taken into consideration, such as diagnosis, previous treatment course and history of apnea or airway obstruction. Potential surgeries include a pharyngeal flap, sphincter pharyngoplasty, Furlow Z-plasty and fat injections. If surgery is required, a one- to two-night stay at the hospital is typical depending on the age of your child. He or she will likely be on a six-week diet restriction. Some symptoms may resolve immediately, but sometimes “typical” speech can take months to years to develop.
- Speech therapy. Speech therapy teaches correct placement of sounds, how to use the tongue, teeth and lips to make sounds and how to direct airflow out of the mouth correctly during speech production. Articulation errors related to velopharyngeal dysfunction can, at times, be difficult to treat and are easier to prevent. This is why monitoring by a cleft and craniofacial team is important. The duration of therapy varies for each child and can range from months to years. Your child’s speech pathologist will clarify which aspects of speech should improve with surgery and which should improve with speech therapy.
Key Points to Remember
Key Points to Remember
- Velopharyngeal dysfunction occurs when the mouth and nasal cavity are not separated appropriately during speech production.
- This condition causes problems with speaking and swallowing.
- The dysfunction occurs with cleft palate in many cases, but not always.
- Surgery is typically necessary for velopharyngeal dysfunction, and speech therapy may also be needed.
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