Velopharyngeal incompetence in cleft palate patients - flexible video pharyngoscopy & perceptual speech assessment.

Velopharyngeal in-competence(VPI) is a common abnormality seen in Cleft palate patients causing hyper nasal speech which is a major communicative disorder in such patients. Assessment of this VPI is complex process due the Velopharyngeal apparatus being a combination of soft palate structures that regulate the airflow from the lungs and larynx through the mouth for oral sounds through the nose for nasal sounds. The present study of perceptual speech and flexible video endoscopy in patients with cleft palate pathology indicates a co-relation between speech defect and type of VPI. In management of patients with cleft palate, it is important that surgical correction of the defect is done at the same time achieving velopharyngeal competency for speech without creating nasal airway obstruction. Velopharyngeal endoscopy with speech assessment will define the anatomic and functional bases for the velopharyngeal correction and also to plan /tailor pharyngeal flaps. This approach also appears to be a useful and necessary tool for ‘surgical feedback’. Hence a multidisciplinary approach involving Otolaryngologists / Plastic surgeons / Speech pathologists for preoperative evaluation of the defect with perceptual speech analysis and velopharyngeal endoscopy is mandatory