Velopharyngeal dysfunction (VPD) is a general term. It is used to describe different disorders of the velopharyngeal valve. These include:
To understand velopharyngeal dysfunction, you need to first understand normal velopharyngeal function for speech.
Figure 1 shows the structures of the roof of the mouth. These are the hard palate and the soft palate (also called the velum).
The velopharyngeal valve is very important for normal speech production. This valve is made up of the following structures:
Figure 2 shows the velum resting against the back of the tongue for nasal breathing. This allows the air that is inhaled through the nose to go through the throat (pharynx) to the lungs and back up again.
Figure 3 shows how the velum closes against the back wall of the throat during speech. The side walls close against the velum so that all of these structures come together as a valve. When the velopharyngeal valve closes, the air and sound are sent into the mouth for speech.
Figure 1. Anatomy of the oral cavity
Figure 2. Velum during nasal breathing
Figure 3. Velum during speech
Illustrations from:
Kummer AW. (2014). Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance, 3rd Edition. Clifton Park, NY: Delmar Cengage.
Figure 4 shows velopharyngeal insufficiency, which is usually caused by an abnormality of soft palate. Velopharyngeal insufficiency is common in children with cleft palate or a submucous (under the skin) cleft. Signs of a submucous cleft are often hard to see when looking in the mouth. Sometimes a submucous cleft can only be seen by putting a scope in the nose to see the top of the soft palate.
Velopharyngeal insufficiency can also occur after adenoidectomy. This is because the adenoids are in the area where the velopharyngeal valve closes. For some children, adenoids help the valve close.
Figure 5 shows the position of the adenoid pad in the throat.
Figure 4. Velopharyngeal insufficiency (the velum is too short for closure)
Figure 5. Adenoids in the pharynx (throat)
Figure 6 shows velopharyngeal incompetence, which is caused by poor movement of the velopharyngeal structures. This is due to a disorder or injury of the brain or cranial nerves. Cerebral palsy and traumatic brain injury are examples of disorders that cause velopharyngeal incompetence.
Figure 6. Velopharyngeal incompetence (the velum doesn’t move well enough for closure)
Velopharyngeal mislearning is when the child makes sounds in the pharynx, rather than in the mouth. Because of this placement, the velopharyngeal valve is open and the air and sound go through the nose, just like when there is velopharyngeal insufficiency.
Last Updated 12/2023
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