Inadequate closure the velopharyngeal sphincter, a MUSCLE at the back of the soft palate, that directs air flow to the NOSE or to the MOUTH. Velopharyngeal insufficiency often accompanies CLEFT PALATE/CLEFT PALATE AND LIP anomalies and interferes with both speech and swallowing. It also can occur as a complication of tonsillectomy and adenoidectomy, operations to remove the tonsils and ADENOIDS, respectively, and of neurologic damage, such as from STROKE, that restricts neuromuscular function of the pharynx. The hallmark symptoms of velopharyngeal insufficiency are nasal speech and regurgitation food into the back of the nose with swallowing. Sometimes the person has chronic or recurrent SINUSITIS resulting from food particles becoming trapped in the sinuses. The doctor may be able to feel a previously undiagnosed cleft in the hard palate beneath an intact soft palate. ULTRASOUND or COMPUTED TOMOGRAPHY (CT) SCAN can confirm the diagnosis.
Treatment for velopharyngeal insufficiency when the cause is a structural anomaly begins with surgery to restore sphincter function to the extent possible. Operations may include repair of a cleft palate or reconstructive surgery to extend the soft palate (pharyngoplasty) to make the velopharyngeal opening smaller. Most people subsequently need speech therapy to retrain oralfacial structures to form the sounds the velopharyngeal insufficiency kept them from properly making. These therapeutic interventions typically restore complete function, though may not be appropriate or successful when the cause of the velopharyngeal insufficiency is neurologic damage or a neuromuscular disorder.
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