January 05, 2019

Ways to Surgically Correct Velopharyngeal Insufficiency (VPI)

Recently, a video was created describing a medical condition called velopharyngeal insufficiency or VPI. This medical condition is characterized by hypernasal speech and if severe enough, food and liquid nasal regurgitation during swallow. Essentially, VPI is due to a persistent opening between the soft palate and back wall during speech. This continuous opening allows air escape during speech and food/liquid nasal regurgitation during swallow if severe enough.

A new video (shown above) has been created to describe the 4 basic ways VPI can be corrected surgically. Surgical correction entails restoring velopharyngeal closure during speech and swallow, but without causing nasal obstruction.

The 4 surgical approaches described in the video are (click link to specifically watch only the described procedure):

1) Posterior pharyngeal wall injection
2) Furlow palatoplasty (double opposing z-plasty)
3) Sphincter pharyngoplasty
4) Posterior pharyngeal flap (video shown below as well)

To determine which surgical approach is best in order to correct a VPI defect, an endoscopic procedure known as video nasopharyngoscopy must be performed.

Once endoscopy characterizes the size and location of the VPI defect along with identifying the velopharyngeal closure pattern, the flowchart shown below may be used to provide a general idea of which surgical approach may be considered.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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