Semin Speech Lang 2011; 32(2): 150-158
DOI: 10.1055/s-0031-1277717
© Thieme Medical Publishers

Types and Causes of Velopharyngeal Dysfunction

Ann W. Kummer1
  • 1Senior Director, Division of Speech Pathology, Cincinnati Children's Hospital Medical Center, Professor of Clinical Pediatrics and Professor of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
Further Information

Publication History

Publication Date:
26 September 2011 (online)

ABSTRACT

The velopharyngeal valve is responsible for production of oral speech sounds. There are three components to normal velopharyngeal function: anatomy, physiology, and learning. Velopharyngeal dysfunction (VPD) is a condition where the velopharyngeal valve does not close consistently and completely during the production of oral sounds. Velopharyngeal dysfunction can be caused by abnormal anatomy (velopharyngeal insufficiency), abnormal neurophysiology (velopharyngeal incompetence), or particular articulation errors (velopharyngeal mislearning). The purpose of this article is to acquaint the reader with what is required for normal velopharyngeal function. In addition, there will be a discussion of the types of velopharyngeal dysfunction and various causes of each. Implications for treatment and prognosis will be discussed.

REFERENCES

  • 1 D'Antonio L L, Muntz H R, Province M A, Marsh J L. Laryngeal/voice findings in patients with velopharyngeal dysfunction.  Laryngoscope. 1988;  98 (4) 432-438
  • 2 Folkins J W. Velopharyngeal nomenclature: incompetence, inadequacy, insufficiency, and dysfunction.  Cleft Palate J. 1988;  25 (4) 413-416
  • 3 Jones D L. Velopharyngeal function and dysfunction.  Clin Commun Disord. 1991;  1 (3) 19-25
  • 4 Loney R W, Bloem T J. Velopharyngeal dysfunction: recommendations for use of nomenclature.  Cleft Palate J. 1987;  24 (4) 334-335
  • 5 Marsh J L. Cleft palate and velopharyngeal dysfunction.  Clin Commun Disord. 1991;  1 (3) 29-34
  • 6 Morris H L. Some questions and answers about velopharyngeal dysfunction during speech.  Am J Speech Lang Pathol. 1992;  1 (3) 26-28
  • 7 Netsell R. Velopharyngeal dysfunction. In: Yoder D, Kent R, eds. Decision-Making in Speech-Language Pathology. Toronto, Canada: B.C. Decker; 1988: 150-151
  • 8 Penfold C N. Management of velopharyngeal dysfunction.  Br J Oral Maxillofac Surg. 1997;  35 (6) 454
  • 9 Witt P D, O'Daniel T G, Marsh J L, Grames L M, Muntz H R, Pilgram T K. Surgical management of velopharyngeal dysfunction: outcome analysis of autogenous posterior pharyngeal wall augmentation.  Plast Reconstr Surg. 1997;  99 (5) 1287-1296 discussion 1297-1300
  • 10 Brunner M, Dockter S, Feldhusen F et al.. Different patterns of velopharyngeal dysfunction in cleft palate patients.  HNO. 2007;  55 (11) 851-857
  • 11 Kummer A W. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Clifton Park, NY: Cengage Delmar Learning; 2008
  • 12 Kummer A W. Assessment of velopharyngeal function. In: Losee J, Kirschner R, eds. Comprehensive Cleft Care. New York, NY: McGraw Hill; 2009: 589-605
  • 13 Rintala A E, Haapanen M L. The correlation between training and skill of the surgeon and reoperation rate for persistent cleft palate speech.  Br J Oral Maxillofac Surg. 1995;  33 (5) 295-71 discussion 297-298
  • 14 Witt P D, Wahlen J C, Marsh J L, Grames L M, Pilgram T K. The effect of surgeon experience on velopharyngeal functional outcome following palatoplasty: is there a learning curve?.  Plast Reconstr Surg. 1998;  102 (5) 1375-1384
  • 15 Reiter R, Haase S, Brosch S. Submucous cleft palate—an often late diagnosed malformation.  Laryngorhinootologie. 2010;  89 (1) 29-33
  • 16 Haapanen M L, Heliövaara A, Ranta R. Hypernasality and the nasopharyngeal space. A cephalometric study.  J Craniomaxillofac Surg. 1991;  19 (2) 77-80
  • 17 Mason R M, Warren D W. Adenoid involution and developing hypernasality in cleft palate.  J Speech Hear Disord. 1980;  45 (4) 469-480
  • 18 Morris H L, Wroblewski S K, Brown C K, Van Demark D R. Velar-pharyngeal status in cleft palate patients with expected adenoidal involution.  Ann Otol Rhinol Laryngol. 1990;  99 (6 Pt 1) 432-437
  • 19 Siegel-Sadewitz V L, Shprintzen R J. Changes in velopharyngeal valving with age.  Int J Pediatr Otorhinolaryngol. 1986;  11 (2) 171-182
  • 20 Ren Y F, Isberg A, Henningsson G. Velopharyngeal incompetence and persistent hypernasality after adenoidectomy in children without palatal defect.  Cleft Palate Craniofac J. 1995;  32 (6) 476-482
  • 21 Kummer A W, Billmire D A, Myer III C M. Hypertrophic tonsils: the effect on resonance and velopharyngeal closure.  Plast Reconstr Surg. 1993;  91 (4) 608-611
  • 22 MacKenzie-Stepner K, Witzel M A, Stringer D A, Laskin R. Velopharyngeal insufficiency due to hypertrophic tonsils. A report of two cases.  Int J Pediatr Otorhinolaryngol. 1987;  14 (1) 57-63
  • 23 Misra U C, Gill R S, Lal M. Tonsil transposition into posterior pharyngeal wall in palato-pharyngeal incompetence.  J Laryngol Otol. 1981;  95 (7) 713-716
  • 24 Peterson-Falzone S J. Velopharyngeal inadequacy in the absence of overt cleft palate.  J Craniofac Genet Dev Biol Suppl. 1985;  1 97-124
  • 25 Shprintzen R J, Sher A E, Croft C B. Hypernasal speech caused by tonsillar hypertrophy.  Int J Pediatr Otorhinolaryngol. 1987;  14 (1) 45-56
  • 26 Andreassen M L, Leeper H A, MacRae D L. Changes in vocal resonance and nasalization following adenoidectomy in normal children: preliminary findings.  J Otolaryngol. 1991;  20 (4) 237-242
  • 27 Donnelly M J. Hypernasality following adenoid removal.  Ir J Med Sci. 1994;  163 (5) 225-227
  • 28 Eufinger H, Eggeling V, Immenkamp E. Velopharyngoplasty with or without tonsillectomy and/or adenotomy—a retrospective evaluation of speech characteristics in 143 patients.  J Craniomaxillofac Surg. 1994;  22 (1) 37-42
  • 29 Fernandes D B, Grobbelaar A O, Hudson D A, Lentin R. Velopharyngeal incompetence after adenotonsillectomy in non-cleft patients.  Br J Oral Maxillofac Surg. 1996;  34 (5) 364-367
  • 30 Kummer A W, Myer III C M, Smith M E, Shott S R. Changes in nasal resonance secondary to adenotonsillectomy.  Am J Otolaryngol. 1993;  14 (4) 285-290
  • 31 Parton M J, Jones A S. Hypernasality following adenoidectomy: a significant and avoidable complication.  Clin Otolaryngol Allied Sci. 1998;  23 (1) 18-19
  • 32 Robinson J H. Association between adenoidectomy, velopharyngeal incompetence, and submucous cleft.  Cleft Palate Craniofac J. 1992;  29 (4) 385
  • 33 Schmaman L, Jordaan H, Jammine G H. Risk factors for permanent hypernasality after adenoidectomy.  S Afr Med J. 1998;  88 (3) 266-269
  • 34 Gibb A G, Stewart I A. Hypernasality following tonsil dissection—hysterical aetiology.  J Laryngol Otol. 1975;  89 (7) 779-781
  • 35 Kummer A W, Strife J L, Grau W H, Creaghead N A, Lee L. The effects of Le Fort I osteotomy with maxillary movement on articulation, resonance, and velopharyngeal function.  Cleft Palate J. 1989;  26 (3) 193-199 discussion 199-200
  • 36 McCarthy J G, Coccaro P J, Schwartz M D. Velopharyngeal function following maxillary advancement.  Plast Reconstr Surg. 1979;  64 (2) 180-189
  • 37 Haapanen M L, Kalland M, Heliövaara A, Hukki J, Ranta R. Velopharyngeal function in cleft patients undergoing maxillary advancement.  Folia Phoniatr Logop. 1997;  49 (1) 42-47
  • 38 Maegawa J, Sells R K, David D J. Pharyngoplasty in patients with cleft lip and palate after maxillary advancement.  J Craniofac Surg. 1998;  9 (4) 330-335 discussion 336-337
  • 39 Okazaki K, Satoh K, Kato M, Iwanami M, Ohokubo F, Kobayashi K. Speech and velopharyngeal function following maxillary advancement in patients with cleft lip and palate.  Ann Plast Surg. 1993;  30 (4) 304-311
  • 40 Watzke I, Turvey T A, Warren D W, Dalston R. Alterations in velopharyngeal function after maxillary advancement in cleft palate patients.  J Oral Maxillofac Surg. 1990;  48 (7) 685-689
  • 41 Phillips J H, Klaiman P, Delorey R, MacDonald D B. Predictors of velopharyngeal insufficiency in cleft palate orthognathic surgery.  Plast Reconstr Surg. 2005;  115 (3) 681-686
  • 42 Janulewicz J, Costello B J, Buckley M J, Ford M D, Close J, Gassner R. The effects of Le Fort I osteotomies on velopharyngeal and speech functions in cleft patients.  J Oral Maxillofac Surg. 2004;  62 (3) 308-314
  • 43 Bodin I K, Lind M G, Arnander C. Free radial forearm flap reconstruction in surgery of the oral cavity and pharynx: surgical complications, impairment of speech and swallowing.  Clin Otolaryngol Allied Sci. 1994;  19 (1) 28-34
  • 44 Brown J S, Zuydam A C, Jones D C, Rogers S N, Vaughan E D. Functional outcome in soft palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flap.  Head Neck. 1997;  19 (6) 524-534
  • 45 Fee Jr W E, Gilmer P A, Goffinet D R. Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site.  Laryngoscope. 1988;  98 (11) 1220-1226
  • 46 Myers E N, Aramany M A. Rehabilitation of the oral cavity following resection of the hard and soft palate.  Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. 1977;  84 (5) ORL941-ORL951
  • 47 Rintala A E. Solitary metastatic melanoma of the soft palate.  Ann Plast Surg. 1987;  19 (5) 463-465
  • 48 Yoshida H, Michi K, Yamashita Y, Ohno K. A comparison of surgical and prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects.  J Oral Maxillofac Surg. 1993;  51 (4) 361-365
  • 49 Yorkston K M, Beukelman D R, Traynor C D. Articulatory adequacy in dysarthric speakers: a comparison of judging formats.  J Commun Disord. 1988;  21 (4) 351-361
  • 50 Bradley D. Congenital and acquired velopharyngeal inadequacy. In: Bozch Z, ed. Communicative Disorders Related to Cleft Lip and Palate. Austin, TX: Pro-Ed; 1997: 23-243
  • 51 Trost-Cardamone J E. Coming to terms with VPI: a response to Loney and Bloem.  Cleft Palate J. 1989;  26 (1) 68-70
  • 52 Warren D W, Dalston R M, Mayo R. Hypernasality in the presence of “adequate” velopharyngeal closure.  Cleft Palate Craniofac J. 1993;  30 (2) 150-154
  • 53 Warren D W, Dalston R M, Trier W C, Holder M B. A pressure-flow technique for quantifying temporal patterns of palatopharyngeal closure.  Cleft Palate J. 1985;  22 (1) 11-19
  • 54 Rousseaux M, Lesoin F, Quint S. Unilateral pseudobulbar syndrome with limited capsulothalamic infarction.  Eur Neurol. 1987;  27 (4) 227-230
  • 55 Luce E A, McGibbon B, Hoopes J E. Velopharyngeal insufficiency in hemifacial microsomia.  Plast Reconstr Surg. 1977;  60 (4) 602-606
  • 56 Funayama E, Igawa H H, Nishizawa N, Oyama A, Yamamoto Y. Velopharyngeal insufficiency in hemifacial microsomia: analysis of correlated factors.  Otolaryngol Head Neck Surg. 2007;  136 (1) 33-37
  • 57 McDonald E T, Baker H K. Cleft palate speech: an integration of research and clinical observation.  J Speech Disord. 1951;  16 (1) 9-20
  • 58 Falk M L, Kopp G A. Tongue position and hypernasality in cleft palate speech.  Cleft Palate J. 1968;  5 228-237
  • 59 Abdullah S. A study of the results of speech language and hearing assessment of three groups of repaired cleft palate children and adults.  Ann Acad Med Singapore. 1988;  17 (3) 388-391
  • 60 Fletcher S G, Daly D A. Nasalance in utterances of hearing-impaired speakers.  J Commun Disord. 1976;  9 (1) 63-73
  • 61 Ysunza A, Vazquez M C. Velopharyngeal sphincter physiology in deaf individuals.  Cleft Palate Craniofac J. 1993;  30 (2) 141-143
  • 62 Subtelny J D, Whitehead R L, Samar V J. Spectral study of deviant resonance in the speech of women who are deaf.  J Speech Hear Res. 1992;  35 (3) 574-579
  • 63 Smith B E, Kuehn D P. Speech evaluation of velopharyngeal dysfunction.  J Craniofac Surg. 2007;  18 (2) 251-261 quiz 266-267
  • 64 Marsh J L. The evaluation and management of velopharyngeal dysfunction.  Clin Plast Surg. 2004;  31 (2) 261-269

Ann W KummerPh.D. 

Division of Speech Pathology, MLC 4011, Cincinnati Children's Hospital Medical Center

3333 Burnet Avenue, Cincinnati, OH 45229-3039

Email: ann.kummer@cchmc.org

    >