Velopharyngeal incompetence

Specialty: Otolaryngology.

• Nasal air leak when speaking
• nasal food reflux
• functional velopharyngeal insufficiency

Why it occurs

• Cleft palate or cleft palate (submucosal or hidden)
• Post-surgical sequelae of adenoidectomy or uvulopalatopharyngoplasty
• Palsy of cranial nerves IX, X, or XII secondary to central neurological pathology (e.g., stroke or progressive bulbar palsy)
• Myasthenia gravis with progressive bulbar muscle fatigue

Initial workup

Dynamic nasofibrolaryngoscopy (to directly visualize the closure pattern of the velopharyngeal sphincter during the emission of oral pressure words), videofluoroscopy of swallowing and speech, acoustic nasometry, and MRI of the brain and brainstem if an underlying neurological cause is suspected.

Standard management

• Management is fundamentally specialized speech therapy, surgery (flap pharyngoplasties, sphincteroplasties) or through the use of palatal prosthetic obturators.
• If there is suspicion of Myasthenia gravis, treatment with cholinesterase inhibitors such as pyridostigmine is prescribed by neurology.