Abstract
Velopharyngeal insufficiency (VPI) is a condition where the soft palate and posterior oropharynx fail to close adequately, leading to complications such as abnormal speech, nasal regurgitation and nasal emission. Although there exist many approaches to treating VPI depending on the shape and severity of the insufficiency, this chapter describes the three most frequently used and well-researched techniques: the Furlow Palatoplasty (double-opposing Z-palatoplasty), the creation and placement of a pharyngeal flap, and a sphincter pharyngoplasty. This chapter contains an introduction to VPI causes and treatment, a description of patient assessment methods, step-by-step instructions for the different operative procedures, and the recovery process.
Highlights
The velopharyngeal sphincter separates the nasopharynx from the oropharynx and is located where the soft palate meets the posterior oropharyngeal wall
In cases where the patient already experiences obstruction, a sphincter pharyngoplasty may be better since postoperative breathing obstruction is less than in a posterior pharyngeal flap placement
Adenoidectomy is often necessary before pharyngoplasty or pharyngeal flap. This is because removal of the adenoids facilitates in raising the pharyngeal flap and in optimizing the pharynx for attachment of the flaps during sphincter pharyngoplasty
Summary
The velopharyngeal sphincter separates the nasopharynx from the oropharynx and is located where the soft palate meets the posterior oropharyngeal wall. The sphincter closes to stop airflow up to the nasal cavity for consonant pronunciation and to prevent nasal regurgitation. It opens to produce certain nasal vocalizations and for normal breathing. Velopharyngeal Insufficiency (VPI) occurs when the sphincter cannot close completely and can cause hypernasality, nasal emissions, nasal regurgitation of food and liquid and communication difficulties. Possibilities for surgery include Furlow Double Opposing Z-Palatoplasty, sphincter pharyngoplasty, posterior pharyngeal wall injection, or pharyngeal flap pharyngoplasty. These approaches vary based on availability of flap tissue-source, individual closure pattern, and severity of VPI. Correcting VPI can help a patient to gain the ability to effectively communicate, as well as their confidence in doing so by minimizing emissions and improving intelligibility [2, 3]
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