Velopharyngeal Insufficiency: Subjective and Objective Assessments
Benjamas Prathanee PhD1, Sanguansak Thanaviratananich MD1
Affiliation : 1 Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : To determine 1) the role, function of structures, and patterns of Velpharyngeal [VP] gap formation among people
with Cleft lip and palate [CLP], and 2) the inter-reliability between 2 investigators on the objective assessment of VP gap and
its respective patterns.
Materials and Methods : This was a descriptive and retrospective study data collection among. Patients with velopharyngeal
insufficiency [VPI]’s medical records were retrieved. Outcomes of perceptual assessment and objective evaluation of
velopharyngeal movement (using Motic plus 2.0 software) were analyzed. Descriptive analyses, intra-class correlations, and
Kappa coefficient were used to characterize the data.
Results : Twenty-three participants between 8 and 47 years of age were enrolled. Oronasal fistula was found 23.81% Coronal
patterns of the VP gap and tongue compensation movement were common in patients with VPI. The respective correlation
coefficient between the perceptual resonance rating scale and nasalance scores for Thai standard passages My house, Winter,
and Laying Hen was 0.37 (95% CI = -0.06, 0.68), 0.26 (95% CI = -0.19, 0.62), and 0.30 (95% CI = -0.14, 0.64). The
respective correlation coefficient between the nasalance scores for the Thai standard passages and articulation types was
-0.29 (95% CI = -0.63, 0.16), -0.41 (95% CI = -0.71, 0.03), and -0.19 (95% CI = -0.57, 0.25). The correlation coefficient for
articulation types and the perceptual resonance rating scale was 0.08 (95% CI = -0.22, 0.58). The intra-class correlation
coefficient between the two investigators for VP gap for each sound was 0.78 to 0.82, while the range of kappa coefficient
between the two investigators for the VP pattern gap for each sound was 0.16 to 0.30.
Conclusion : Velum had the primary role vis-a-vis VP function while the posterior pharyngeal wall had minimal function in
VP gap formation. Coronal patterns of VP gap and tongue compensation movement were common in patients with VPI.
Keywords : VPI, Cleft lip and palate, Objective measurement, Oronasal fistula
