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Page: Velopharyngeal Insufficiency
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Velopharyngeal insufficiency (VPI) is defined as the failure to close the velopharyngeal sphincter, resulting in an inability to adequately separate the nasal cavity from the oral cavity(Armour et al., 2005) When there is a pharyngeal gap in the velopharyngeal sphincter during speech, air leaks into the nasal cavity resulting in a hypernasal voice resonance and nasal emissions (Sloan, 2000) Secondary effects of VPI include speech articulation errors (e.g., distortions, substitutions, and omissions) and compensatory misarticulations (e.g., glottal stops and posterior nasal fricatives) (Hill, 2001). VPI is most commonly caused by a cleft of the secondary palate, but other causes may include: submucous clefts, neuromuscular abnormalities, and congenital VPI of unknown cause (Sloan, 2000). Additionally, approximately 20-30% of patients develop VPI post primary palatoplasty (Heliovaara et al., 2003). Possible treatment options include speech therapy, prosthetics, augmentation of the posterior pharyngeal wall, lengthening of the palate, and surgical procedures (Sloan, 2000).
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