CODI 546 - Craniofacial Anomalies
Velopharyngeal Dysfunction & Resonance Disorders

 Velopharyngeal Dysfunction: Underlying Etiology
 1. Velopharyngeal Insufficiency (VPI)-  Structural defect causes the velum to be short relative to the posterior pharyngeal wall
 2. Velopharyngeal Incompetence (VPI) -  Physiological deficiency that results in poor movement of the velopharyngeal structures
 3. Velopharyngeal Mislearning -  Abnormal resonance and nasal air emission without a primary velopharyngeal disorder (functional)
Causes of Velopharyngeal Insufficiency
 1. History of cleft palate or submucous cleft
  •  20% show inadequate velar length following surgical repair
  •  Submucous cleft causes gap along midline during closure
  •   2. Short velum or deep pharynx   3. Status Postadenoidectomy  4. Adenoid atrophy -  Onset of VPI around puberty
    5.  Irregular adenoids -  Deep indentation or cleft in adenoid tissue prevents tight seal & leads to nasal air emission during speech; May occur after adenoidectomy
    6.  Postmaxillary advancement -  7. Oral Cavity Tumors
    8.  Hypertrophic tonsils  Causes of Velopharyngeal Incompetence
     1.  Abnormal muscle insertion
     2.  Poor lateral pharyngeal wall movement
     3.  Dysarthria (central or peripheral nerve damage)  4.  Apraxia of speech -  Inability to correctly time upward & downward movements during speech for oral vs nasal sounds
    Velopharyngeal Mislearning
     1.Faulty Articulation   2. Habituated Speech Patterns
      3.  Lack of Auditory Feedback
      4.  Conversion Disorders -  Learned reaction to a certain event for example following tonsillectomy
    Effects of Velopharyngeal Dysfunction on Speech
     1. Hypernasality  2.Nasal air emission  3. Nasal rustle (nasal turbulence)  4.  Nasal snort -  Forcible emission of air through the nose during consonant production producing a noisy, sneeze-like sound -associated with /s/
     5.  Nasal grimace
     6.  PSNAE
     7.  Weak or Omitted Consonants
     8.   Short Utterance Length
     9.  Compensatory Articulation Productions  10.  Dysphonia  Resonance Disorders
     1.  Hypernasality due to velopharyngeal dysfunction
     2.  Hyponasality usually due to obstruction
     3.  Cul-de-sac resonance  4.  Mixed resonance

     Predicting Severity of Effects on Speech
     1.  Co-vary with articulatory & phonatory status
     2.  Small VP opening can have an increased effect on quality & intelligibility
     3.  Moderate opening has less effect
     4.  Large opening usually greatest effect causing: