What’s New in Cleft Palate and Velopharyngeal Dysfunction Management: An Update |Journal CME Article-42957

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The article discusses the pathology, diagnosis, and treatment of velopharyngeal dysfunction (VPD), particularly in patients with a cleft palate. VPD results from inadequate functioning of the structures controlling the velopharyngeal sphincter, affecting speech by altering air pressure and sound flow between the oral and nasal cavities. The paper highlights hypernasal resonance, nasal air emission, and reduced speech pressure as symptoms of VPD, which can arise after cleft palate repair.<br /><br />The article focuses on VPD secondary to cleft palate, with around 30% of repaired patients needing further surgery due to velopharyngeal insufficiency (VPI). Diagnosis involves perceptual speech assessment, video nasendoscopy, fluoroscopy, MRI, and nasometry, which help determine the presence and cause of VPD. Treatment options include speech therapy, prosthetics, and surgical interventions such as palatal lengthening with buccal myomucosal flaps, Furlow palatoplasty, sphincter pharyngoplasty, and pharyngeal flaps.<br /><br />Surgical management is tailored based on anatomy and the specific cause of VPI—whether from inadequate palatal length or mobility. Techniques like the Furlow double-opposing Z-plasty and the novel use of buccal myomucosal flaps for palatal lengthening are discussed, along with methods to address cases of poor palatal mobility or those requiring additional surgical intervention after primary repair.<br /><br />The report emphasizes the importance of a multidisciplinary team for diagnosis and treatment, highlighting the evolving role of diagnostic tools and emerging surgical practices in improving speech outcomes for VPD patients following cleft palate repair. The article suggests that treatment plans should be evidence-based and customized to each patient's needs to optimize results and ensure the safety of the airway over time.

Keywords

velopharyngeal dysfunction

cleft palate

speech therapy

surgical intervention

hypernasal resonance

diagnostic tools

multidisciplinary team

palatal lengthening

speech outcomes

airway safety