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Velopharyngeal dysfunction

What is velopharyngeal dysfunction?

When a person swallows, speaks or drinks, muscles and structures in the back of the throat come together to seal off the opening between the mouth and the nose. This keeps air and food from leaking into the nose from the mouth. In a child with velopharyngeal dysfunction (vee-lo-fair-un-GEE-ul dis-FUNK-shun), something doesn’t work correctly, so the seal doesn’t close all the way.

Symptoms of velopharyngeal dysfunction

Children with velopharyngeal dysfunction will have a range of problems with speaking and swallowing. Common symptoms include:

• Nasal emission: Air may leak from the nose when they speak.
• Hypernasality: They may have very nasal sounding speech.
• Nasal regurgitation: They may have food or liquids come out of the nose when they eat or drink.
• Speech problems: There may be sounds they can’t make at all, like the “b” or “p” sounds. Children may develop incorrect ways of speaking to try to compensate for the sounds they can’t make.

These symptoms may be spotted when a child is a very young infant. A baby who is unable to form a seal around a bottle may have velopharyngeal dysfunction.

Types and causes of velopharyngeal dysfunction

There are different types of velopharyngeal dysfunction and many different reasons it can happen. The different types are determined by the specific problems that cause them.

• Velopharyngeal insufficiency (VPI) is caused by structural problems in the throat. A common example is a cleft palate or a submucous cleft palate. VPI can happen as a complication from surgery in the mouth. It can also be part of a syndrome, where there are several abnormalities in different parts of the body that develop in the womb. 22q11 deletion syndrome is one of the most common syndromes associated with VPI.
• Velopharyngeal incompetency happens due to something wrong with the nerves of the throat. This can be part of an inherited problem that is present at birth. It can also happen because of some diseases.
• Mislearning is a type of speech impediment where the throat works as it should, but the child has learned to push air through the nose when speaking. Sometimes this can happen when a child has difficulty hearing.

How is velopharyngeal dysfunction diagnosed?

For the best care, pediatric experts in different fields have to work together to correctly identify the cause of the problem. Finding the right cause is important because different types of velopharyngeal dysfunction require different treatments.

The pediatric specialists on the care team should include:

• Speech-language pathologists
• Plastic surgeons
• Otolaryngologists (Ear, Nose and Throat)
• Oral maxillary facial surgeons
• Neurologists
• Prosthodontists
• Radiologists
• Geneticists

Children’s of Mississippi has pediatric experts in all these specialties with experience in helping children with velopharyngeal dysfunction.

To find out the exact cause of velopharyngeal dysfunction, children may have several different kinds of tests.

A pediatric speech-language pathologist (SLP) may perform an in-depth examination of the child’s speech. The SLP may ask the child to say specific phrases, such as “pet the puppies” or “Kathy kissed the cat.” The SLP may place a mirror under the child’s nose during speech to see if the mirror fogs due to air leaking through the nose.

Other tests, such as video-nasal endoscopy and multiview videofluoroscopy, allow doctors to see the parts of the throat in motion while the child speaks and sucks through a straw. Special X-rays, called cephalometrics, show how different parts of the throat work together during speech. MRIs show doctors details about the muscles and other structures in the throat.

Once the care team has identified the specific cause, the best possible treatment can be determined.

How is velopharyngeal dysfunction treated?

Children with normal throat structure and function who have learned to speak incorrectly can be helped with speech therapy. A pediatric speech-language pathologist will work with children one-on-one to help correct and improve their speech.

Speech therapy cannot overcome problems caused by abnormal throat structures. Children with this problem will need surgery. Usually, this surgery is done when a child is between 3 and 4 years old, but can be done whenever VPI is diagnosed. Surgical options include:

• Lengthening of the palate with buccal flaps
• Pharyngeal flap
• Sphincter pharyngoplasty
• Posterior pharyngeal wall augmentation
• Furlow palatoplasty

After surgery, children may also have speech therapy to help them continue to improve their speech.

Some children with abnormal throat structures may not be able to have surgery. For these children, customized mouth pieces, similar to retainers, may help. These devices, called oral prosthetics, are specially fitted to the child’s mouth by experts called prosthodontists.

The pediatric plastic surgeons at Children’s of Mississippi are experts in treating children with velopharyngeal dysfunction, and will discuss all the possible treatment options for your child.

Can children with velopharyngeal dysfunction lead a normal life?

The sooner a child with velopharyngeal dysfunction is diagnosed and treated, the better. The long-term outlook for children with the condition depends on how severe it is and what caused it. Many children see a great improvement in their speech and quality of life after surgery.

Get help at Children’s of Mississippi

If you are concerned about your child experiencing VPI, you can schedule a consultation at Children’s of Mississippi. We have all the pediatric experts to help find out what the issues may be and plan the best possible treatment. Schedule an appointment online.

Last reviewed: 12/1/2025