Surgery for Velopharyngeal Insufficiency: Velopharyngoplasty

One primary goal of cleft palate repair is the achievement of optimal feeding and normal speech while minimally affecting maxillary growth and development. Velopharyngeal insufficiency (VPI) is a seldom, but typical finding in patients after primary palatoplasty. The most common cause of VPI in cleft palate patients is insufficient length of palate, increased velopharyngeal distance, inadequate levator veli muscle sling, and cicatricial contracture of velum. Aberrant speech production results from dysfunction with characteristic hypernasality, nasal air emissions, and diminished vocal intensity. This yields poorly intelligible speech, which can have profound implications on quality of life. Various surgical approaches are in use to gain normal speech: Furlow palatoplasty, intravelar veloplasty, sphincter pharyngoplasty, and pharyngeal flaps. The VPI surgical management is selected based on the closure pattern and gap size of velopharyngeal port. Pharyngeal flaps are indicated when a large gap is present in patients. The chapter demonstrates the performance of velopharyngoplasty by an inferior and superior pedicled posterior pharyngeal flap. This approach remains a powerful surgical option to treat patients with VPI following cleft palate repair.