Velopharyngeal Insufficiency Clinical Trial
Official title:
Partial Adenoidectomy in Cases of Velopharyngeal Dysfunction
The velopharyngeal valve is a tridimensional muscular valve that is located between the oral and nasal cavities. It consists of the lateral and posterior pharyngeal walls as well as the soft palate. The role of the velopharyngeal valve is to separate the oral and nasal cavities during speech and swallowing.
Velopharyngeal dysfunction is the inability to separate the oral and nasal cavities
adequately during speech production through the actions of the velum and pharynx.
Velopharyngeal dysfunction can be caused due to lack of tissue (velopharyngeal insufficiency)
or lack of proper movement (velopharyngeal incompetence) of the walls. While Velopharyngeal
dysfunction is commonly associated with cleft lip and palate, it can also be seen with
submucous cleft and other noncleft conditions such as ablative palatal lesions,
adenoidectomy, deafness or hearing loss, and cerebral palsy. In Velopharyngeal dysfunction,
the incompletely closed velopharyngeal valve causes an inability to effectively manage the
air stream for continuous speech causing hypernasal speech.
Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with
palatal abnormality.
In 1958, Gibb indicated an incidence of hypernasality postadenoidectomy in approximately 1 of
2000 cases. Closure pattern of velopharyngeal valve in typical patients is velo-adenoidal
rather than velopharyngeal closure. Adenoid mass is vital to velopharyngeal closure in such
patients and removal necessitates a change in the pattern of velopharyngeal valving.
Trans-oral endoscopic partial (superior) adenoidectomy adenoidectomy enables the surgeon to
inspect the velopharyngeal valve during the procedure; thus avoiding occurrence of
velopharyngeal dysfunction.
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