Secondary Palatal Management

A well-orchestrated series of events occur, that we don’t even think about, to generate the sounds that create speech. The tongue moves to certain areas in the mouth, the soft palate rises and moves toward the back wall of the throat, and tissue from the sides of the throat move toward the midline. The airflow through the nose can be actively reduced and redirected out the mouth. If this does not provide the desired sound, speech therapy is needed for improvement.

If the soft palate is too short and unable to reach the back wall of the throat, air can continue to pass through the nose resulting in hypernasal speech. This is called velopharyngeal insufficiency, or VPI.

The work up for VPI includes a physical exam, and if possible, a naso-endoscopy (performed by an ENT) where a small fiber-optic camera is placed in the nose and the closure pattern of the soft palate and surrounding tissue is observed during speech. If it is clear that the soft palate is not reaching the back wall adequately, there are surgeries that can either lengthen the palate (Furlow Z-Plasty), recruit tissue from the back wall of the throat into the soft palate (Pharyngeal Flap), or bring in tissue from the sides (Sphincter Pharyngoplasty).

Decisions regarding Secondary Palatal Management are best made with multidisciplinary input from the Speech Therapist, Otolaryngologist (ENT), and Plastic Surgeon. Preparatory procedures like adenoidectomy are sometimes recommended.

The downside of intentionally reducing nasal airflow is that the speech can become more hypo-nasal, sounding the way people do when they have a cold. Reduced nasal airflow can result in nasal obstruction and even sleep apnea. Revision or reversal of this surgery is sometimes necessary.

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