Velopharyngeal Dysfunction (VPD)

Also called: Velopharyngeal Insufficiency, Velopharyngeal Incompetence (VPI)

What Is Velopharyngeal Dysfunction (VPD)?

When we talk, we send a stream of air through our oral cavity: the mouth, teeth, gums, roof of the mouth, floor of the mouth (under the tongue), and cheeks. This creates the sounds that come out of our mouths.

Velopharyngeal dysfunction (VPD) is when sound and air leaks into the nose during speech.

What Causes Velopharyngeal Dysfunction (VPD)?

Different things can cause velopharyngeal (vee-low-fair-en-JEE-ul) dysfunction, including:

• history of cleft palate
• submucous cleft palate
• 22q11.2 deletion syndrome (DiGeorge syndrome)
• problems with the palate or throat
• adenoidectomy
• traumatic brain injury or other neurological disorders

What Are the Signs & Symptoms of Velopharyngeal Dysfunction (VPD)?

Depending on how severe it is, velopharyngeal dysfunction can affect speech in various ways. Children with VPD might have these signs:

• hypernasality ("nasal sounding" speech)
• speech sound errors
• nasal air emissions (air leaking through the nose during speech)
• weak pressure on some speech sounds
• speech that's hard for others to understand

Kids with VPD also might have food and/or liquid leak through their nose when they eat or drink.

How Is Velopharyngeal Dysfunction (VPD) Diagnosed?

A child with signs of VPD should go to a specialized VPD team or a cleft and craniofacial clinic for an evaluation.

During the evaluation, the family meets with several specialists, such as otolaryngologists (ear, nose, and throat doctors), plastic surgeons, and nurses. They will get the child's medical history and examine the inside of the mouth. A speech-language pathologist will assess the child's speech.

The team may request a nasopharyngoscopy or videofluoroscopy (an X-ray video of the palate during speech). These studies help the team get a better look at the "leak" in the back of the throat that's letting air and sound escape through the nose during speech. The results help with the diagnosis of VPD and treatment planning. Both procedures are quick and the team will discuss them with you (and your child) before getting started.

How Is Velopharyngeal Dysfunction (VPD) Treated?

Speech-language therapy can help correct any abnormal speech sound errors (incorrect pronunciations) that kids may have developed because of their velopharyngeal dysfunction. But speech therapy alone cannot fix VPD. Other treatments may be needed, such as surgery.

Surgical Treatment of VPD

The goal of surgery is to block air and sound energy from leaking out the nose during speech. There are several options to fix VPD. Three common ones are:

• Posterior pharyngeal flap (PPF): The surgeon takes a flap of tissue from the back of the throat and attaches it to the soft palate. This flap blocks air and sound from leaking through the nose during speech. Openings on each side of the flap let the child breathe normally through the nose.
• Sphincter pharyngoplasty: The surgeon takes a flap of tissue from behind each tonsil and connects them across the back of the throat. This makes the overall gap where air is escaping into the nose smaller. It can also help squeeze the gap closed during speech, while letting it stay open during breathing.
• Conversion to Furlow palatoplasty: Depending on the type of initial cleft palate repair a child had, the surgeon may be able to rearrange the scar tissue and repair the speech muscles of the soft palate. This can lengthen the palate and make it better able to close against the back of the throat, improving VPD.
• Palatal lengthening: The surgeon borrows flaps of tissue from the insides of the cheeks (“buccal flaps”) and uses them to make the soft palate longer. Increasing the palate's length also can help it to close against the back of the throat and improve VPD.

Your surgeon will talk about the different options, and suggest the best one for your child. Your child might need more tests before surgery, like a sleep study. This is important because surgeries meant to improve VPD can also cause snoring and pauses in breathing at night (obstructive sleep apnea). Be sure to discuss any questions and concerns with your team.

How Do We Get an Evaluation?

Velopharyngeal dysfunction can have a huge impact on children’s lives. It can affect their ability to make friends and socialize, or to be understood by their teachers and peers. It can even make college or job interviews more challenging in the future. It's not something that kids "outgrow," so it is important to get an evaluation to find the cause.

If you notice signs of VPD in your child, get an evaluation from an experienced team of providers. Even in kids with no history of cleft palate, cleft and craniofacial teams are best able to evaluate and treat this problem.

To find a team in your area, look online at:

• The American Cleft Palate-Craniofacial Association (ACPA)