Chromosomal and Genetic Conditions

Velopharyngeal Insufficiency

What Is Velopharyngeal Insufficiency?

Soft palate at rest

Soft palate at rest.

Velopharyngeal insufficiency (VPI) is a disorder resulting in the improper closing of the velopharyngeal sphincter (soft palate muscle in the mouth) during speech, allowing air to escape through the nose instead of the mouth.

During speech, the velopharyngeal sphincter must close off the nose to properly pronounce strong consonants such as "p," "b," "g," "t" and "d."

To close off the nose from the mouth during speech, several structures come together to achieve velopharyngeal closure.

Normal speech

Normal speech.

These include the velum (soft palate or roof of the mouth), the lateral pharyngeal walls (side walls of the throat) and the posterior pharyngeal wall (the back wall of the throat).

If the velopharynx is not closed, snort sounds may be produced through the nose or you may hear air coming out of the nose during speech.

Improper function of this structure also produces a nasal tone in the voice.

Velopharyngeal Insufficiency in Children

Any child with cleft palate is at risk for VPI.

The most common cause of VPI is a history of cleft palate or submucous cleft (cleft covered by the lining or mucous membrane of the roof of the mouth).

About 20% to 30% of children who have cleft palate with or without cleft lip will have persisting VPI after their palate repair. A small percentage of children with submucous cleft palate will also have VPI.

Sometimes VPI develops after an adenoidectomy (a surgical procedure to remove adenoids or lymphoid tissue in the back of the nose).

Children who are born with weak throat muscles or who suffer a traumatic brain injury that results in weak throat muscles may have VPI. Sometimes children have VPI from an unknown cause.

Velopharyngeal Insufficiency at Seattle Children's

Our craniofacial team has a great deal of experience treating velopharyngeal insufficiency. Two speech pathologists on the team specialize in identifying VPI speech symptoms and in differentiating VPI from other speech problems.

They also perform specialized radiological tests to assess velopharyngeal function in children.

Two otolaryngologists (ear, nose and throat specialists) are experienced in specialized endoscopic tests (viewing the inside of an organ) to assess velopharyngeal function in children.

Our team has surgeons skilled in performing speech surgeries and a dentist who works with a speech pathologist to make prosthetic speech appliances.