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Velopharyngeal Dysfunction Clinic

Experts at the Velopharyngeal Dysfunction Clinic, a part of our cleft and craniofacial services at ������� Langone, provide team-based diagnosis and treatment of speech difficulties associated with this complex condition.

Velopharyngeal dysfunction, a resonance disorder that is also known as VPD, is typically diagnosed in childhood. Signs and symptoms that you may notice in your child include the following:

• hypernasal speech
• an excessive amount of air coming through the nose when speaking
• speech that sounds “weak” in pressure
• food or liquid escaping through the nose while eating

Our specialists, which include a speech–language pathologist, registered dietitian, nurse practitioner, psychologist, social worker, a craniofacial orthodontist, and craniofacial plastic surgeons, work together to provide your child with a unique and multidisciplinary care plan.

Types of Velopharyngeal Dysfunction

There are three types of velopharyngeal dysfunction.

Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) occurs when the soft palate—commonly referred to as the roof of the mouth—cannot effectively close off the nasal cavity, the hollow spaces in the nose, for speech and sound production. This may occur because of an underlying structural problem. The palate may be too short to reach the back of the throat, or the muscle involved in closing off the nasal cavity may not be in the right place. Surgery is usually recommended to address this issue.

Velopharyngeal Incompetence

Velopharyngeal incompetence is when the soft palate does not close at the right time, despite being long enough. This is because the palate is not getting the right signals from the brain to close off the nasal cavity for certain sounds. This often arises from nervous-system conditions such as apraxia, in which putting words or syllables together in the proper order is difficult; dysarthria, which is when poor muscle tone makes it difficult to produce sounds; or a traumatic brain injury (TBI). Your child may benefit from a specialized combination of speech therapy, a prosthetic device designed to help close the gap between the soft palate and the back of the throat, improving speech clarity, or surgery.

Velopharyngeal Mislearning

Velopharyngeal mislearning occurs when the soft palate is able to effectively close off the nasal cavity for speech sound production, but the patient forms one or more of the sounds for speech incorrectly. This form of velopharyngeal dysfunction can be addressed through speech therapy.

Evaluation and Diagnosis

Our providers use various techniques to determine the cause of velopharyngeal dysfunction and to create a care plan for your child. Diagnosis may include the following:

• perceptual speech evaluation, in which the speech–language pathologist listens for differences in your child’s speech sounds
• oral motor examination, when a doctor or speech–language pathologist checks for how well the muscles in the mouth and throat are working
• nasoendoscopy, also called nasopharyngoscopy, when a doctor uses a flexible tube with a camera on the tip to view how the palate and throat move during speech

We may also refer your child for genetic testing at �����о��� Langone’s Clinical Genetic Services or to interdisciplinary cleft and craniofacial services for additional evaluation.

A Team-Based Care Plan

Our team can provide a personalized treatment plan for your child that may include speech therapy, surgery to improve velopharyngeal function, or a combination of both.

Speech Therapy

Our speech–language pathologist specializes in treating speech errors caused by velopharyngeal dysfunction. Every therapy plan is uniquely designed, with the frequency and duration of sessions depending on each child’s needs. Sessions are play-based, to provide a comfortable environment. Our speech–language pathologist can also provide treatment recommendations for community-based therapists already involved in your child’s care.

Surgical Procedures for Velopharyngeal Insufficiency

Our pediatric plastic surgeons are trained in surgery for velopharyngeal insufficiency to address the underlying structural issue to improve your child’s ability to communicate. Surgical recommendations, based on your child’s evaluation, may include one of the following:

• pharyngeal flap, in which tissue from the back of the pharynx—meaning the area where the upper part of the throat connects with the back of the nose—is used to close the gap between the soft palate and throat, improving speech clarity
• sphincter pharyngoplasty, which repositions muscles in the pharynx to create a better seal during speech, reducing nasal air leakage
• palatal lengthening procedures, which extend the soft palate, often use tissue from the inside of the cheeks, or buccal flaps, to close the gap during speech
• posterior pharyngeal wall augmentation, in which filler is injected into the pharynx to reduce the amount of air that escapes during speech

If surgery is recommended for your child’s velopharyngeal insufficiency, our social work, nutrition, and nursing teams can help support you and your family through the myFace Family Support Center at �����о��� Langone for craniofacial care. Your child also receives a speech evaluation before and after surgery to assess the improvements made.

Our Care Team

Our specialists work with you to create a compassionate and thorough treatment plan for your child.

Roberto L. Flores, MD
David A. Staffenberg, MD
Meg M. Lico, SLP

Contact Us

Our Velopharyngeal Dysfunction Clinic is at 222 East 41st Street on the 22nd floor. For more information or to schedule an appointment, please call 212-263-5834.