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velopharyngeal_insuff

velopharyngeal_insuff

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This e book discusses the topic velopharyngeal insufficiency, its features and management
This e book discusses the topic velopharyngeal insufficiency, its features and management

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Published by: Dr. T. Balasubramanian on Oct 24, 2011
Copyright:Attribution Non-commercial

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07/05/2014

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VelopharyngealInsufficiency and itsmanagement
Dr T Balasubramanian
 
Velopharyngeal insufficiency
Introduction:Velopharyngeal insufficiency includes any dysfunction that causes insufficiency / incopetence at the junction of nasopharynx with that of oropharynx. Classically in English language only three phonemes i.e. (n/m/ng) are produced by nasal air escape. All the other sounds are produced by oralair flow. Velopharynx is considered as an articulator along with jaw, lips, tongue, pharynx andlarynx. These articulators infact work cohesively to produce meaningful speech.Velopharyngeal closure occurs as the velum moves in the postero superior direction. The lateral pharyngeal walls move medially sealing the nasopharynx from oropharynx.Factors affecting velopharyngeal valve during speech:1.Height of the vowel2.Type of consonant3.Proximity of nasal sounds to oral sounds4.Length of utterance5.Speech rate6.Tongue heightAny abnormality in the velopharyneal closure mechanims leads to abnormal speech.Velopharyngeal incompetance:This leads to:a. Hypernasality b. Nasal turbulencec. Speech disturbances due to abnormal articulationMuscles acting on velopharynx:Tensor veli palatini:This muscle tenses the soft palate and opens the auditory tube during swallowing. This muscle issupplied by the mandibular division of trigeminal nerve.Levator veli palatini:It pulls the velum in a postero superior direction thus acting as a major elevator of velum. It alsoserves to hold velum in its superior position. It derives its motor nerve supply from pharyngeal plexus which are formed from branches of glossopharyngeal, vagus and facial nerves. This muscleoccupies the intermediate 40% of the length of the soft palate.Musculus uvulae:It arises from palatal aponeurosis posterior to the hard palate. It inserts into the uvula. This muscleadds the much needed bulk to the upper surface of palate. It derives its motor supply from pharyngeal plexus.Drtbalu's otolaryngology online
 
Palatoglossus:This muscle constitutes the anterior pillar of tonsil. It terminates on the side of base of tongue. Itserves to elevate the tongue upwards and backwards. It has the potential to lower the velum andhold it in position. Its nerve supply is via the pharyngeal plexus.Palatopharyngeus:This muscle forms the posterior pillar of tonsil. It arises from soft palate and inserts into the posterior border of thyroid cartilage. By adducting posterior pillars it is able to narrow the pharyngeal isthumus. It also raises the larynx, lowers pharynx and maintains the position of velum.It derives its nerve supply via the pharyngeal plexus.Superior constrictor:This muscle isone of the most important constrictor of pharynx. When it contracts it draws thevelum posteriorly managing to shut it of during the process of swallowing. This muscle is supplied by pharyngeal plexus.The major muscle mass of velum is levator veli palatini. The elevation and posterior motion of velum is attributed to this muscle. Variations in the angle of insertion to the skull base involvingthis muscle may change elevation angle of soft palate. The action of this muscle is opposed by palatoglossus and palatopharyngeus muscles.Lateral wall movements of velum show individual variations. It also depends on speech context.Lateral movement of velum is attributed to selective contraction of uppermost fibers of superior constrictor muscle. Since the lateral fibres of superior constrictor is closely related to palatopharyngeus it goes without saying that palatopharyngeus muscle is also involved in this typeof movement.Passavant's ridge:This is actually a thickening present in the posterior wall of nasopharynx. This feature is seen insome individuals while speaking / swallowing. It is more common in patients with cleft palate.This thickening is caused by uppermost fibres of superior constrictor and palatopharyngeus muscle.This projection may involved in velopharyngeal closure.Causes of velopharyngeal incompetence:According to DAntonio and Crockett velopharyngeal incompetence can be divided into threecategories:1.Insufficiency: This encompasses sturctural defects involving soft palate resulting ininsufficient tissue to accomplish perfect closure of velopharynx. A well known example of this condition is cleft palate.2.Incompetence: This is due to motor defects caused by neurologic dysfunction like paresis /Drtbalu's otolaryngology online

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