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Normal Velopharyngeal Function

To understand velopharyngeal dysfunction, you need to first understand normal velopharyngeal function for speech.

The velopharyngeal valve is very important for normal speech production. This valve is made up of the following structures:

• Velum (also called soft palate)
• Lateral pharyngeal walls – the side walls of the throat
• Posterior pharyngeal wall – the back wall of the throat

Types of Velopharyngeal Dysfunction

Velopharyngeal dysfunction (VPD) is a general term. It is used to describe different disorders of the velopharyngeal valve. These include:

• Velopharyngeal insufficiency (VPI), which is due to abnormal structure
• Velopharyngeal incompetence (VPI), which is due to abnormal movement
• Velopharyngeal mislearning, which is due to abnormal speech sound production

Velopharyngeal Insufficiency

Velopharyngeal Insufficiency (VPI) is usually caused by an abnormality of soft palate. Velopharyngeal insufficiency is common in children with cleft palate or a submucous (under the skin) cleft. Signs of a submucous cleft are often hard to see when looking in the mouth. Sometimes a submucous cleft can only be seen by putting a scope in the nose to see the top of the soft palate. Velopharyngeal insufficiency can also occur after adenoidectomy. This is because the adenoids are in the area where the velopharyngeal valve closes. For some children, adenoids help the valve close.

Velopharyngeal Incompetence

Velopharyngeal Incompetence (VPI) is caused by poor movement of the velopharyngeal structures. This is due to a disorder or injury of the brain or cranial nerves. Cerebral palsy and traumatic brain injury are examples of disorders that cause velopharyngeal incompetence.

Velopharyngeal Mislearning

Velopharyngeal Mislearning is when the child makes sounds in the pharynx, rather than in the mouth. Because of this placement, the velopharyngeal valve is open and the air and sound go through the nose, just like when there is VPI. 

Velopharyngeal Dysfunction and Speech

Velopharyngeal dysfunction causes a leak of sound and/or air into the nose during speech. It can cause several speech problems, including:

• Hypernasality, where there is too much sound in the nose during speech
• Nasal emission of air when making certain speech sounds
• Weak consonants because of the leak of air through the nose
• Making speech sounds in the throat due to the lack of air in the mouth 

Velopharyngeal Dysfunction Treatment

The treatment of a velopharyngeal dysfunction depends on the type and cause of the problem. The treatment of velopharyngeal insufficiency or velopharyngeal incompetence usually requires surgery. When surgery is needed for VPI, the surgery does not change the way the child has already learned to talk. For more information on VPI insufficiency treatment, visit the VPI Clinic.

Speech therapy is usually needed after the operation to help the child learn how to make sounds correctly. If the problem is due to velopharyngeal mislearning, speech therapy alone will correct abnormal speech.

Sources:

Velopharyngeal dysfunction. Cincinnati Childrens. (n.d.). Retrieved October 26, 2021, from https://www.cincinnatichildrens.org/health/v/velopharyngeal.