Why It’s Important to Treat Your Child’s Velopharyngeal Insufficiency
There’s a lot of misinformation about velopharyngeal insufficiency (VPI). In the past, blowing, sucking, and oral-motor exercises have been prescribed to assist your child’s velopharyngeal closure, but we now know that these exercises are not effective in treating VPI. Instead, surgery is almost always necessary to correct this disorder. As a board-certified plastic surgeon who specializes in craniofacial and pediatric reconstructive surgery, Dr. Sharline Aboutanos helps children who suffer from VPI. In this blog, she explains what velopharyngeal insufficiency is and why it’s important to treat it in your child.
What is VPI?
In order to perform basic oral activities such as swallowing and speaking, the velopharyngeal valve—the muscle that separates the oral and nasal cavities (called the velopharyngeal port)—needs to be able to close adequately. VPI occurs when this valve lacks sufficient tissue to separate these cavities, allowing air to escape through the nose during speech and causing hypernasal speech. Children who suffer from VPI have a difficult time pronouncing high-pressure oral consonants, such as p, b, t, d, k, and g.
What causes VPI?
Children often experience VPI due to a cleft palate, submucous cleft palate, or surgery to correct a cleft palate (palatoplasty). Cleft palate patients have a shortened palate, which makes it difficult for their velopharyngeal valve to close completely when they speak, eat, and breathe. Other causes of VPI include:
A history of adenoidectomy (removal of the adenoids—glands in the roof of the mouth that sometimes grow too large)
Cervical spine anomalies
Oral/pharyngeal tumor removal
Traumatic brain injuries or neurological disorders that weaken muscles and make it difficult to control one’s velopharyngeal valve
What issues are associated with VPI?
According to a 2017 study, children with VPI have a difficult time communicating, making socializing with peers difficult and embarrassing. Children with severe VPI may also have a hard time eating and drinking, as the opening in their velopharyngeal port may allow food and fluids to be regurgitated through their nose.
If left untreated, VPI will worsen with age. Your child may develop maladaptive speech articulations to compensate for their mispronunciations, which can be very difficult to treat. Children who suffer from VPI tend to have higher rates of ear infections, which could impact hearing and even lead to hearing loss.
How do you diagnose VPI?
Visit a speech pathologist. They will perform an evaluation of your child’s pronunciation, oral and nasal resonance, and nasal emission during their speech. They will also use a special computer-aided headset called a nasometer to assess the amount of sound energy coming from your child’s nose and mouth.
Visit a craniofacial plastic surgeon or ENT doctor. If you suspect your child has VPI, visit a craniofacial plastic surgeon—preferably one who specializes in pediatric care—or an ENT doctor (otolaryngologist). They will examine your child’s ears, nose, and throat to determine if there is a VPI, and if so, its severity. These doctors may also perform a nasoendoscopy to better view your child’s palate while they are talking and to determine the size and shape of their velopharyngeal gap.
How do you treat VPI?
VPI is treated by an interdisciplinary team of specialists, usually consisting of a speech pathologist, an ENT doctor, and a plastic surgeon. If surgery is needed, visit a plastic surgeon who specializes in pediatric reconstructive surgery.
Surgical options
There is no one surgery to treat all VPI patients; rather, the type of surgery needed is determined by the size and shape of a child’s velopharyngeal gap. The purpose of all VPI surgeries is to close this gap.
Furlow palatoplasty. Also called double-opposing Z-plasty, this surgery extends the palate to adequately cover the velopharyngeal gap. This procedure can be used on all VPI patients regardless of their primary palatoplasty technique. It can also be used to repair a submucosal cleft palate and to augment a palatoplasty.
Pharyngeal flap. This is the most common VPI surgery. It involves taking tissue from the back of the throat and attaching it to the soft palate to prevent air from escaping through the nose during speech.
Sphincter pharyngoplasty. This surgery involves transferring tissue from the sides of the throat behind the tonsils to the back of the throat to decrease the size of your child’s velopharyngeal gap and prevent air from escaping during their speech.
Posterior wall pharyngeal augmentation. This surgery is done by injecting filler material—such as collagen, your child’s own fat, or a formulated product—into your child’s velopharyngeal gap.
While surgery helps close your child’s velopharyngeal gap to prevent air from escaping through their nose, many children will require speech therapy after their procedure to correct any compensatory articulations developed as a result of VPI. Typically a speech evaluation is performed six weeks after surgery to assess whether speech therapy will be needed.
Non-surgical options
Though surgery is normally the required treatment for VPI, sometimes a prosthetic speech aid can be used either temporarily or permanently. There are two types of speech aids: the speech bulb and the palatal lift prosthesis.
Speech bulb. This prosthesis consists of an orthodontic-like retainer that fits in your child’s mouth and has an attached “speech bulb.” This bulb helps close off the space between your child’s soft palate and their throat, reducing hypernasality when they speak. It is taken out at night while they sleep.
Palatal lift. A palatal lift prosthesis is also similar to an orthodontic retainer, but instead of using a speech bulb to cover your child’s velopharyngeal gap, it raises their soft palate enough so that they can close the gap on their own.
Award-winning pediatric surgery in Richmond, VA
As an award-winning, board-certified pediatric plastic surgeon, Dr. Sharline Zacur Aboutanos is experienced in treating VPI and other cleft and craniofacial disorders. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and will help coordinate your child’s care with other specialists in a multi-disciplinary manner. Contact Dr. Aboutanos online or by calling (804) 355-3410 to coordinate your child’s pediatric care in the Richmond area today.