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Velopharyngeal Incompetence:: A Guide for Clinical Evaluation

Johns, Donnell F. Ph.D.; Rohrich, Rod J. M.D.; Awada, Mariam M.D.

Plastic and Reconstructive Surgery: December 2003 - Volume 112 - Issue 7 - p 1890-1898
doi: 10.1097/01.PRS.0000091245.32905.D5

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the mechanism of speech production. 2. Recognize the specific cause of a speech abnormality (structural deficit, neurogenic deficit, misarticulation, or mechanical interference). 3. Perform a thorough clinical assessment using an intraoral examination and speech production analysis. 4. Understand the advantages and disadvantages of various types of instrumental modalities and their specific indications in diagnosing speech abnormalities.

Various causes of velopharyngeal disorders and the myriad of diagnostic methods used by speech-language pathologists and plastic surgeons for assessment are described in this article. Velopharyngeal incompetence occurs when the velum and lateral and posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech and deglutination. The functional goals of cleft palate operations are to facilitate normal speech and hearing without interfering with the facial growth of a child. Basic and helpful techniques are presented to help the cleft palate team identify preoperative or postoperative velopharyngeal incompetence. This information will enable any member of the multidisciplinary cleft palate team to better assist in the differential diagnosis and management of patients with speech disorders.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication April 24, 2003;

revised May 30, 2003.

Rod J. Rohrich, M.D.

Department of Plastic Surgery

University of Texas Southwestern Medical Center

5323 Harry Hines Boulevard, E7.212

Dallas, Texas 75390-9132

©2003American Society of Plastic Surgeons