Velopharyngeal inadequacy
Encyclopedia
Velopharyngeal inadequacy (VPI) is a malfunction of a velopharyngeal mechanism.
The velopharyngeal mechanism is responsible for directing the transmission of sound energy and air pressure in both the oral cavity and the nasal cavity
. When this mechanism is impaired in some way, the valve
does not fully close, and a condition known as 'velopharyngeal inadequacy' can develop. VPI can either be congenital or acquired later in life.
Although the definitions are similar, the etiologies correlated with each term differ slightly; however, in the field of medical professionals these terms are typically used interchangeably. Velopharyngeal inadequacy is the generic term most often used to describe the functionality of the velopharyngeal valve.
, where tissue from the back of the mouth is used to close part of the gap. Other ways of treating velopharyngeal insufficiency is by placing a posterior nasopharyngeal wall implant (commonly cartilage or collagen) or type of soft palate lengthening procedure (i.e. VY palatoplasty).
The velopharyngeal mechanism is responsible for directing the transmission of sound energy and air pressure in both the oral cavity and the nasal cavity
Nasal cavity
The nasal cavity is a large air filled space above and behind the nose in the middle of the face.- Function :The nasal cavity conditions the air to be received by the other areas of the respiratory tract...
. When this mechanism is impaired in some way, the valve
Valve
A valve is a device that regulates, directs or controls the flow of a fluid by opening, closing, or partially obstructing various passageways. Valves are technically pipe fittings, but are usually discussed as a separate category...
does not fully close, and a condition known as 'velopharyngeal inadequacy' can develop. VPI can either be congenital or acquired later in life.
Terminology
Different terms can be used to describe this phenomenon in addition to “velopharyngeal inadequacy”. These terms and definitions are as follows:- Velopharyngeal insufficiency: The inability of the velopharyngeal sphincterSphincterA sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
to sufficiently separate the nasal cavity from the oral cavity during speech.
- Velopharyngeal incompetency: When the soft palateSoft palateThe soft palate is the soft tissue constituting the back of the roof of the mouth. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone....
and the lateral/posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech.
Although the definitions are similar, the etiologies correlated with each term differ slightly; however, in the field of medical professionals these terms are typically used interchangeably. Velopharyngeal inadequacy is the generic term most often used to describe the functionality of the velopharyngeal valve.
Relationship to cleft palate
A cleft palate is one of the most common causes of VPI. Cleft palate is an anatomical abnormality that occurs in utero and is present at birth. This malformation can affect the lip, the lip and palate, or the palate only. A cleft palate can affect the mobility of the velopharyngeal valve, thereby resulting in VPI.Classification
The most frequent types of cleft palates are overt, submucous, and occult submucous.Causes
While cleft is the most common cause of VPI, other significant etiologies exist. These other causes are outlined in the chart below:Treatment
A common method to treat Velopharyngeal insufficiency is pharyngeal flap surgeryPharyngeal flap surgery
Pharyngeal flap surgery is a procedure to correct the airflow during speech. The procedure is common amongpeople with cleft palate and some types of dysarthria.-Pharyngeal flap procedures:...
, where tissue from the back of the mouth is used to close part of the gap. Other ways of treating velopharyngeal insufficiency is by placing a posterior nasopharyngeal wall implant (commonly cartilage or collagen) or type of soft palate lengthening procedure (i.e. VY palatoplasty).