Chromosomal and Genetic Conditions

Velopharyngeal Insufficiency Treatment

As speech develops, children form lifelong speech habits. Good speech habits might not develop if the child cannot direct air through the mouth. If poor speech patterns persist, they are often hard to change later.

Our goal is to eliminate velopharyngeal insufficiency (VPI) to enable a child to develop normal speech patterns. In addition to closing the velopharynx during speech, it is important that your child be able to breathe through their nose.

A team of professionals does a careful exam of each child. VPI is usually treated with surgery or with a speech appliance, often called an obturator.

Velopharyngeal Insufficiency Treatment Options

Speech therapy

Some speech problems linked with VPI, such as mispronouncing words, can be treated by speech therapy.

Treatment focuses on teaching the child the correct manner and place of articulation. In most cases, VPI speech symptoms cannot be decreased solely by speech treatment.

Speech appliances

VPI obturator


Sometimes an obturator is recommended to treat VPI.

An obturator is like a modified dental retainer with a speech bulb or palatal lift attached to the back. Each obturator is shaped uniquely to fit the patient's muscle movements.

The steps to make the appliance are taken by the dentist over several visits to the dental clinic.

A speech pathologist joins the team in the final stages of fitting the obturator and helps to monitor its ongoing effectiveness. It is worn during the day and taken out at night for sleep.

An obturator can be a short- or long-term option for children with VPI. It can be used before or instead of surgery. Some children start with an obturator and have surgery when they are older and some children continue to use an obturator as adults.

Speech surgery

There are several surgical procedures designed to treat VPI. All are performed inside the mouth under general anesthesia. Most times, the child needs to stay in the hospital overnight.

Speech with VPI after surgery

Speech with VPI after surgery.

At Children's Craniofacial Center the procedures performed most often are the Furlow palatoplasty and the sphincter pharyngoplasty.

The Furlow palatoplastyis designed to bring the abnormally positioned muscles of the palate into a more normal position so the palate can move better.

When doing a sphincter pharyngoplasty, the surgeon moves tissue from the back of the throat closer to the back of the palate.

A sphincter pharyngoplastysurgery is recommended when the surgeon decides that the palate is working as well as it can, but the back of the throat isn't moving correctly.

Sometimes a child will have minimal movement of the palate or the throat and may require both of these surgeries to be done at the same time.

Some patients who have surgery will still have VPI and may require additional surgery.

If your child is a good candidate for surgery, your surgeon and the speech pathologist will discuss the type of surgery that is needed and when it should be performed. Your child's speech will be checked again after surgery.