Velopharyngeal Insufficiency (VPI)

What Is Velopharyngeal Insufficiency (VPI)?

Velopharyngeal insufficiency (VPI) is a congenital or acquired disorder that results in the improper closing of the soft palate muscle in the mouth (the velopharyngeal sphincter) during speech. Because this sphincter does not close properly, air escapes through the nose instead of the mouth. This insufficiency does not allow the child to properly pronounce consonant sounds such as "p," "b," "g," "t", and "d."

The velopharyngeal valve consists of:
  • Velum (soft palate)
  • Lateral pharyngeal walls (side walls of the throat) 
  • Posterior pharyngeal wall (the back wall of the throat) 
Our internationally recognized team of surgeons and cross-disciplinary specialists work together to provide top-level quality care for your child while offering the utmost concern and support for your family.

Causes of Velopharyngeal Insufficiency (VPI)

As a parent, it can be troubling if you are not sure why your child has velopharyngeal insufficiency. Yet in some cases, the cause remains unknown.

In most cases of velopharyngeal insufficiency, the child is also born with cleft palate. Any child with cleft palate has a 20 to 30 percent chance of having velopharyngeal insufficiency. Rarely, the insufficiency can happen when the adenoids are removed.

Children born with weak throat muscles or who have sustained a traumatic brain injury can acquire velopharyngeal insufficiency.


Symptoms of Velopharyngeal Insufficiency (VPI)

If the velopharynx is not closed properly, you may hear your child producing grunting sounds through his or her nose, or you can hear air coming out through the nose while he or she speaks. Also, your child’s voice may have a nasal quality.

Although common in children with cleft palate, the abnormality may be visible only by having a scope put in the nose to look at the top side of the velum, or soft palate.

This should be used as a guideline. Not every symptom is included. If your child has one or more of these symptoms, it does not mean that he or she has velopharyngeal insufficiency (VPI). If you are concerned that your child might have velopharyngeal insufficiency (VPI), please make an appointment with your child's doctor.


Treatments for Velopharyngeal Insufficiency (VPI)

The treatment of velopharyngeal insufficiency usually requires surgery, such as a tonsillectomy, pharyngeal flap, sphincter pharyngoplasy, or posterior pharyngeal wall implant. The implant can be either temporary or permanent.

However, after surgery, speech therapy will still be necessary to change speech patterns already acquired by your child.

At the Yale Craniofacial Program, we understand that it can be overwhelming when your child has to undergo surgical treatment. That is why we create a treatment plan and review it with you, making sure that you feel comfortable with the procedure and what you can expect.