African American mother and her daughter

What Is A Velopharyngeal Insufficiency?

If air escapes through your child's nose while they're speaking, and it affects their ability to form certain sounds, they have a condition called velopharyngeal insufficiency. We'll let you know what causes this condition and what you can do to treat it so your child can grow up with a level of oral health that makes you both smile.

What Is Velopharyngeal Insufficiency?

First, let's break down the name of the condition to understand better what it means.

  • Velo
    This refers to your velum – the soft area on the roof of your mouth near your throat.
  • Pharyngeal
    This refers to your pharynx (or throat).
  • Insufficiency
    When most people speak, their soft palate and throat stop air from going up through their nose to make the necessary speech sounds. An insufficient amount of tissue in the velum or pharynx to close off that passageway is the reason for velopharyngeal insufficiency.

What Causes Velopharyngeal Insufficiency?

  • Cleft Palates
    Cleft palates are the most common cause of this condition. Clefts develop during the first few weeks of pregnancy if the tissue that forms the mouth's roof doesn't join correctly. The National Institute of Craniofacial Research estimates that 2,650 babies are born with cleft palates each year in the United States. According to Stanford Children's Health, about 20% of children with repaired cleft palates experience velopharyngeal insufficiency.
  • Adenoidectomies
    Your child's adenoids work with their tonsils to trap germs in their mouth and nose. MedlinePlus says that adenoids begin shrinking at about age 5 and are almost completely gone by your child's teenage years. Sometimes adenoids need to be removed, and the procedure can create space between your child's velum and the back of their throat, but this usually resolves itself in a matter of weeks and rarely persists long-term. Some reasons for adenoid removal include:
    • Repeated infection
    • If they are large and block your child's airway
    • A bacterial infection that's resistant to antibiotics
  • Velocardiofacial syndrome
    This is a genetic disorder caused when a piece of chromosome 22 is missing and can result in heart problems and a cleft palate. Even when this syndrome doesn't cause a cleft palate, it can result in velopharyngeal insufficiency.
  • Unknown Causes
    In some cases, the causes of velopharyngeal insufficiency are unknown.

Diagnosis and Treatment for Velopharyngeal Insufficiency

If you suspect that your child may have velopharyngeal insufficiency, your healthcare professional may refer you to a speech pathologist. A speech pathologist will be able to put a small scope in your child's nose to see how your child's palate moves when they are talking (a nasendoscopy).

Minor cases could be improved through speech therapy. One of the following surgeries (with tongue-twisting names) may be recommended depending on the size and type of gap in your child's pharynx:

  • Furlow palatoplasty
    This procedure realigns palatal muscles, lengthening and thickening the velum, so it can naturally reach the back of the throat.
  • Sphincter pharyngoplasty
    Takes tissue from both sides of the tonsils and connects them at the back of the throat to create a more narrow opening
  • Pharyngeal flap
    A flap of tissue is taken from the back of the throat and added to the velum.
  • Posterior pharyngeal wall injection augmentation
    Implant materials are placed in the walls of the throat either through incision or injection.

If your child has one of these procedures, speech therapy will likely be recommended to help them relearn how to pronounce certain sounds after recovering from the surgery.

Velopharyngeal Insufficiency and Oral Health

If your child has a cleft palate, it can affect more than the roof of their mouth and the way they speak – it can also impact the positioning, size, shape, and number of their teeth. And consistent exposure to the air can dry up saliva and allow bacteria to flourish. According to studies performed by the University of Washington, people with this facial difference may have abnormal salivary glands that can adversely affect their oral health, too. So people with clefts tend to have a higher than average rate of tooth decay.

Therefore, practicing good oral hygiene and seeing a dental professional for regular checkups is of the utmost importance to ensure a future with healthy teeth. Start brushing early, at least twice a day. It's recommended that you schedule your child's first dental appointment early. Many dentists suggest bringing children with clefts in for a checkup well before their first birthday so they can identify potential issues.

Whether your child has velopharyngeal insufficiency due to a cleft or another reason, be sure to ask your dental professional if they have any recommendations on how to best care for your child's specific needs. If you return regularly for checkups, your dental professional will be able to monitor for developing tooth decay or any other oral hygiene issues.

When you have a child with an unexpected condition that arises, it can be scary, but you can help them stay positive and use this as a great learning tool for their future. When they overcome this, they'll realize they can overcome anything. And any time spent with your little one is a chance to have some fun. You've got this!

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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