Fundamentals of Velopharyngeal Insufficiency

The velopharyngeal insufficiency (VPI) is the inability of the velopharyngeal sphincter to seal the communication between the nasal cavities and the inferiorly located rest of the vocal tract during speech. The anatomical components of the velopharyngeal sphincter are the soft palate (velum), and the lateral and posterior pharyngeal walls. The etiology of VPI could be congenital or acquired. The most common cause of velopharyngeal insufficiency is cleft palate. The purpose of this chapter is to present an update of VPI. A brief review of the anatomy and physiology of the velopharyngeal sphincter is provided. The clinical and instrumental procedures for an accurate diagnosis of VPI are also addressed. This chapter emphasizes that patients presenting with VPI require a transdisciplinary team for an adequate diagnosis and treatment plan. The team should include at least a surgeon, a speech pathology clinician, a radiologist, and an anesthesiologist. However, other specialists may be necessary to be included in the craniofacial and cleft palate team.