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Velopharyngeal insufficiency

short outline of Velopharyngeal insufficiency treatment options

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Velopharyngeal insufficiency

  1. 1. Velopharyngeal Insufficiency By: Dr. Mohammed A. Aljodah M.B.Ch.B. MRCSEd
  2. 2. Definition • VPI is the inability to achieve closure of the velopharyngeal port during sustained speech.
  3. 3. causes • cleft of the secondary palate and submucous cleft palate. • neuromuscular abnormalities. • Adenoidectomy. • congenital VPI of unknown etiology. • Pharyngomegaly .
  4. 4. Signs • Hypernasality. • nasal emission. • Imprecise consonant production. • decreased vocal intensity (loudness), • short phrases
  5. 5. DDX • hearing difficulties • abnormal speech habits. • psychosocial delay. • tongue restriction.
  6. 6. Preoperative Evaluation. • Clinical examination: • intraoral examination will determine if an intravelar veloplasty was performed at the time of cleft palate repair and if the levator sling is functioning appropriately.
  7. 7. multiview videofluoroscopy and nasopharyngoscopy • Provides information regarding the posterior and superior movement of the velum as "M:U as the degree of medial excursion of the lateral pharyngeal walls during speech.
  8. 8. TREATMENT • NON SURGICAL: • speech therapy. • prosthetic management with speech bulb or palatal lift appliances. • posterior pharyngeal injections or implants.
  9. 9. speech bulb
  10. 10. palatal lift appliances
  11. 11. Surgical 1. Palatal surgery: secondary palate lengthening procedure such as a Furlow palatoplasty.
  12. 12. Pharyngeal Surgery • Pharyngeal Flaps.
  13. 13. • Sphincter Pharyngoplasty.
  14. 14. Pharyngeal Flaps. • Longitudinal incisions through the mucosa and muscle down to the fascia on each side of the posterior pharyngeal wall. Dissection is continued along the fascia. A superiorly based flap is transversely incised inferiorly and raised to a level above the palatal plane, An inferiorly based flap is incised just below the adenoid pad. The flap is usually inset with tum-back flaps on the nasal side of the uvula.
  15. 15. Sphincter Pharyngoplasty • superiorly based flaps raised from the posterior tonsilar pillars, including mucosa and the palatopharyngeus muscle. • the flaps are transposed to the midline and inset into a defect created by a transverse incision at the level of the flap base.
  16. 16. Complications of Pharyngeal Surgery • Bleeding. • airway obstruction, • sleep apnea.(resolve within 5 months ) • surgical revision of the flap.