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Velopharyngeal dysfunction — Clinical Guidelines

Overview

Velopharyngeal dysfunction (VPD) involves inadequate closure of the velopharyngeal valve during speech production, leading to speech disorders such as hypernasality or nasal regurgitation. It encompasses various etiologies including velopharyngeal incompetence, insufficiency, and mislearning 3.

Diagnosis

Clinical History and Physical Examination: Essential for initial evaluation 3.

Perceptual Speech Analysis: Evaluates hypernasal resonance and articulation errors 2.

Objective Techniques: Nasometry and speech endoscopy provide quantitative measures 4.

Grading: Often assessed subjectively but standardized tools can aid in consistent evaluation 2.

Management

Speech Therapy: Primary nonsurgical intervention, including biofeedback techniques 1 9.

Prosthetic Devices: Modular palatal lift prostheses with silicone velar lamina for improved oral-nasal balance 6.

Surgical Interventions: Autogenous posterior pharyngeal wall augmentation for structural defects 11.

Behavioral Approaches: Total obturation of the velopharynx for hypodynamism 7.

Multidisciplinary Teams: Collaboration among speech therapists, dental specialists, and maxillofacial technicians enhances outcomes 8.

Special Populations

Pediatrics: Early intervention is crucial; timing of surgical interventions impacts speech outcomes 10.

Comorbidities: Patients with conditions like 22q11.2 deletion syndrome may require tailored prosthetic-behavioral approaches 7.

Key Recommendations

Utilize Multidisciplinary Teams for Comprehensive Management: Collaboration among specialists improves treatment efficacy (Evidence: Moderate 8).

Consider Early Surgical Interventions in Pediatric Patients: Timing of surgery can significantly influence speech outcomes (Evidence: Moderate 10).

Implement Biofeedback Techniques in Speech Therapy: Nasopharyngoscopic biofeedback shows promise in improving VPD (Evidence: Weak 9).

Evaluate and Use Prosthetic Devices for Structural Defects: Modular prostheses can effectively manage hypernasality (Evidence: Weak 6).

Assess Patient Satisfaction Post-Treatment: Self-assessment questionnaires provide valuable insights into treatment success (Evidence: Moderate 5).

References

1 Cler GJ, Mittelman T, Braden MN, Woodnorth GH, Stepp CE. Video Game Rehabilitation of Velopharyngeal Dysfunction: A Case Series. Journal of speech, language, and hearing research : JSLHR 2017. link 2 Butts SC, Truong A, Forde C, Stefanov DG, Marrinan E. Perceptual Assessment of Velopharyngeal Dysfunction by Otolaryngology Residents. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2016. link 3 Glade RS, Deal R. Diagnosis and Management of Velopharyngeal Dysfunction. Oral and maxillofacial surgery clinics of North America 2016. link 4 Belcher R, Deshpande A, Goudy S. State of the Art in Treating Velopharyngeal Dysfunction. Facial plastic surgery : FPS 2016. link 5 Stiernman M, Klintö K, Al Qatani AD, Schönmeyr B, Becker M. Subjective outcomes after treatment for velopharyngeal dysfunction. Journal of plastic surgery and hand surgery 2015. link 6 Ayliffe BW, Bressmann T, Al Mardini M, Jokstad A. Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients. The Journal of prosthetic dentistry 2014. link 7 Dutka Jde C, Uemeoka E, Aferri HC, Pegoraro-Krook MI, Marino VC. Total obturation of velopharynx for treatment of velopharyngeal hypodynamism: case report. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2012. link 8 Sell D, Mars M, Worrell E. Process and outcome study of multidisciplinary prosthetic treatment for velopharyngeal dysfunction. International journal of language & communication disorders 2006. link 9 Brunner M, Stellzig-Eisenhauer A, Pröschel U, Verres R, Komposch G. The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2005. link 10 Becker DB, Grames LM, Pilgram T, Kane AA, Marsh JL. The effect of timing of surgery for velopharyngeal dysfunction on speech. The Journal of craniofacial surgery 2004. link 11 Witt PD, O'Daniel TG, Marsh JL, Grames LM, Muntz HR, Pilgram TK. Surgical management of velopharyngeal dysfunction: outcome analysis of autogenous posterior pharyngeal wall augmentation. Plastic and reconstructive surgery 1997. link 12 Ma L, James DR, Sell DA. Failed pharyngoplasty and subsequent management. The British journal of oral & maxillofacial surgery 1996. link90086-8) 13 Sell D, Ma L. A model of practice for the management of velopharyngeal dysfunction. The British journal of oral & maxillofacial surgery 1996. link90087-x)

Velopharyngeal dysfunction