What is VPI?

During speech, the soft palate (i.e., velum) closes against the back wall of the throat (i.e., pharynx), preventing air flow through the nose.

Velopharyngeal insufficiency, or VPI, is a condition that occurs when the soft palate cannot close against the back wall of the throat during speech. With VPI, too much air escapes through the nose and results in hypernasal speech – like the voice is coming through the nose. 

VPI can substantially impact a child’s speech and make it difficult for others to understand them, which can affect school performance, relationships with friends and family, and self-image. 

For these reasons, most children with VPI undergo surgery to improve their speech. There are three general types of surgery performed to treat VPI. Surgeons select one of these surgery types, or variations of a type, based on each patient’s individual situation and their surgical judgment.

Surgery options include:

Pharyngeal flap

In a pharyngeal flap, tissue from the back of the throat is elevated and then connected to the back of the palate. The pharyngeal flap partially obstructs the space between the palate and throat. The partial obstruction significantly reduces the amount of air flow through the nose during speech

Sphincter pharyngoplasty

In a sphincter pharyngoplasty, tissue from the sides of the throat are used to create a pad of tissue on the back of the throat. This narrows the airway passage into the nose, reducing air flow through the nose during speech.

Palate re-repair

In a palate re-repair, the muscles of the palate are reconstructed and repositioned into a more favorable position in the palate. Sometimes this procedure also lengthens the palate. The result is a more effective elevation of the palate, improving the ability of the palate to close against the back of the throat during speech.