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Velopharyngeal Insufficiency


Clarence T. Sasaki

, MD, Yale University School of Medicine

Last full review/revision Jan 2020| Content last modified Jan 2020
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Velopharyngeal insufficiency is incomplete closure of the velopharyngeal sphincter between the oral and nasal cavities, causing a hypernasal voice.

The velopharyngeal sphincter (which includes the soft palate and the side and back walls of the throat) separates the oral and nasal cavities during swallowing and speech. During speech, air is directed through the mouth and not the nose. In velopharyngeal insufficiency, the seal is not complete, allowing air to leak through the nose causing a hypernasal resonant voice (sounding nasally).

Velopharyngeal insufficiency can occur in people born with splitting of the roof of the mouth (cleft palate Cleft Lip and Cleft Palate The most common birth defects of the skull and face are cleft lip and cleft palate, affecting about 2 of every 1,000 babies. Cleft lip is a separation of the upper lip, usually just below the... read more Cleft Lip and Cleft Palate ) or a palate that is too short. It can sometimes develop after tonsil or adenoid surgery or as a result of muscle weakness in people with neurological disorders such as cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of symptoms that involve difficulty moving and muscle stiffness (spasticity). It results from brain malformations that occur before birth as the brain is developing... read more , stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more , or brain tumors Overview of Brain Tumors A brain tumor can be a noncancerous (benign) or cancerous (malignant) growth in the brain. It may originate in the brain or have spread (metastasized) to the brain from another part of the body... read more . Other causes include genetic syndromes such as neurofibromatosis Neurofibromatosis Neurofibromatosis is a group of genetic disorders in which many soft, fleshy growths of nerve tissue (neurofibromas) form under the skin and in other parts of the body, and flat spots that are... read more Neurofibromatosis and tumors in the palate.

Symptoms of velopharyngeal insufficiency include a hypernasal voice with an inability to form speech sounds correctly. Severe velopharyngeal insufficiency can cause solid foods and fluids to regurgitate through the nose.

Doctors suspect velopharyngeal insufficiency in people with the typical speech abnormalities. To confirm the diagnosis, doctors inspect the velopharyngeal sphincter with a fiberoptic nasoendoscope (a flexible tube passed through the nose) or x-rays taken while swallowing different foods (videofluroscopy).

Treatment is with speech therapy and sometimes with a special device worn in the mouth or surgery.

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People differ in their susceptibility to nosebleeds. Some people get them often, others rarely or never. Nosebleeds can be mild, with just a trickle of blood, or severe, with a strong stream of blood. From which of the following areas do nosebleeds usually originate?
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