The goals of VPI (Velopharyngeal Insufficiency) surgery is to eliminate the symptoms of hypernasality and audible nasal emissions without causing total obstruction of the velopharyngeal port, allowing for nasal breathing and nasal resonance. Causes of VPI can be anything from a Cleft Palate, Adenoidectomy, neuromuscular abnormalities and sometimes there’s no known reason for VPI.
The first possible intervention is lengthening the palate by retropositioning the velum, which can be achieved with a Furlow Palatoplasty (double-reversing-Z-plasty). Sometimes, such as certain cases where the issue is less of a palate problem and more of a velum/ pharyngeal problem, pharyngeal flap and sphincter pharyngoplasty is an option.
The second option category involves reduction of the static opening between the nasal and oral pharynges, which is considered a velopharyngeal-narrowing procedure. This narrowing may be accomplished either with a pharyngeal flap or with sphincter pharyngoplasty. The pharyngeal flap creates a single subtotal central obstruction of the velopharyngeal port, leaving 2 open ports laterally. Sphincter pharyngoplasty diminishes the cross-sectional area of the central port.