Different surgical techniques in the management of velopharyngeal insufficiency

the velopharynx is a dynamic structure essential to normal breathing, eating and speaking. The velopharyngeal port closes as the velum moves in a posterior superior direction. The lateral pharyngeal walls move medially. Occasionally, there will be anterior movement of the posterior wall.The Velopharyngeal Dysfunction (VPD) may take place when this valve is unable to perform its own closing, due to a lack of tissue (velopharyngeal insufficiency) or even lack of proper movement (velopharyngeal incompetence).This study was carried in 11 patients with hypernasality of speech and with or without nasal regurgitation of fluid or food.All patients were subjected to full history taking, full general and otorhinolaryngological examination, clinical test for detection of VPD, Gutzman’s (a/i) test and Czernak’s (cold mirror) test and speech endoscopy to determine the pattern and velopharyngeal valve closure and the size and type of the gap during closure of the velopharyngeal valve.According to the gap which is seen in the velopharynx by speech endoscopy, we choose the appropriate operation.If there is minimal central gap, we look for the state of musculus uvula if notched, we do intravelar veloplasty operation and if the musculus uvula is bulged, we do superiorly based pharyngeal flap operation.