Velopharyngeal incompetence is the inability of the soft palate to fulfill its role in closing the nasopharynx, which seriously affects phonation. To produce plosive sounds (p/k/t/d ) or the sibilants (s/sh), the soft palate must touch the posterior pharyngeal wall to close the nasal passage. Failure of closure seriously affects phonation and competent speech, resulting in the typical hypernasal speech.

The most common cause of velopharyngeal incompetence is cleft palate, but patients with congenitally short palates can also have this typical speech pattern. The diagnosis of velopharyngeal incompetence can be suggested by the child's speech. More objective diagnosis can be obtained by direct visualization of the soft palate while the child is pronouncing certain keywords (kah, kah), by fogging of a hand mirror placed under the nose during phonation, and from cinefluorographic films.

Treatment consists of surgical lengthening of the palate by the "pushback" operation with or without pharyngeal flap. In patients with velopharyngeal incompetence, videofluoroscopy and nasopharyngoscopy can provide information that will help select the appropriate procedure, either pharyngoplasty or posterior pharyngeal flap.

References

• Dudas JR, Deleyiannis FW, Ford MD, et al. Diagnosis and treatment of velopharyngeal insufficiency: clinical utility of speech evaluation and videofluoroscopy. Ann Plast Surg. 2006;56:511-517.
• Sullivan SR, Taylor HOB, Stiles E, Nuss RC, Balkin DM, Mulliken JB. Videofluoroscopy versus nasopharyngoscopy of lateral pharyngeal wall movement for assessment of velopharyngeal insufficiency. J Craniofac Surg. 2023;34:40-44.