Velopharyngeal insufficiency is defined as an inability to close the velopharyngeal sphincter resulting in inadequate separation of the oral cavity from the nasal cavity during speech. It is associated with a number of congenital and acquired abnormalities. A multidisciplinary approach that includes a surgeon and speech therapist is desirable. Evaluation of patients for velopharyngeal insufficiency requires a thorough history and examination by the physician. Surgical intervention is frequently required for correction of the hypernasality, and the clinical evaluation should include a description of the size and type of defect present. Fiberoptic endoscopic examination is invaluable in assessing the defects in these patients. Radiologic evaluation also allows a better definition of the type and severity of the defect. This qualitative assessment allows the surgeon to select the appropriate procedure for the type of defect present.
The surgical techniques most commonly used for treatment of velopharyngeal insufficiency are bilateral sphincter pharyngoplasty, Furlow palatoplasty, and superior pharyngeal flap. These technical aspects as well as the advantages and disadvantages of each are discussed.