velopharyngeal insufficiency
TRANSCRIPT
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Velopharyngeal Insufficiency
By: Dr. Mohammed A. AljodahM.B.Ch.B. MRCSEd
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Definition
• VPI is the inability to achieve closure of the velopharyngeal port during sustained speech.
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causes
• cleft of the secondary palate and submucous cleft palate.
• neuromuscular abnormalities.• Adenoidectomy.• congenital VPI of unknown etiology.• Pharyngomegaly .
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Signs
• Hypernasality.• nasal emission. • Imprecise consonant production.• decreased vocal intensity (loudness),• short phrases
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DDX
• hearing difficulties• abnormal speech habits.• psychosocial delay. • tongue restriction.
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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.
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multiview videofluoroscopyand 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.
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TREATMENT
• NON SURGICAL:• speech therapy.• prosthetic management with speech bulb or
palatal lift appliances.• posterior pharyngeal injections or implants.
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speech bulb
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palatal lift appliances
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Surgical
1. Palatal surgery:secondary palate lengthening procedure such as a Furlow palatoplasty.
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Pharyngeal Surgery
• Pharyngeal Flaps.
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• Sphincter Pharyngoplasty.
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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.
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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.
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Complications of Pharyngeal Surgery
• Bleeding.• airway obstruction,• sleep apnea.(resolve within 5 months )• surgical revision of the flap.
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THANK YOU