Disfunción del esfínter velofaríngeo y su tratamiento

Cleft palate is one of the most frequent congenital anomalies. In cleft palate cases there is a dysfunction of the velopharyngeal sphincter for speech production. This dysfunction is due to the structural disorder produced by the cleft and has been named velopharyngeal insufficiency. Cleft palate surgical repair provides a functional restoration of the sphincter in 80-90% of the cases. The remaining cases persist with a residual velopharyngeal insufficiency. Velopharyngeal insufficiency produces magnified nasal resonance during speech. Moreover, the insufficiency can also produce a phonological disorder involving not only the sphincter but the entire vocal tract. The phonological disorder is known as compensatory articulation. Residual velopharyngeal insufficiency requires surgical treatment. Compensatory articulation requires speech therapy. In this paper, variation of velopharyngeal dysfunction is revised, focusing on physiology and pathology of velohparyngeal insufficiency. Surgical options for the treatment in cases of residual velopharyngeal insufficiency and the importance of correcting compensatory articulation through speech intervention prior to the planning of surgical treatment are discussed. Some specific situations related to velopharyngeal insufficiency are revised, such as submucous cleft palate and velocardiofacial syndrome or 22q11.2 deletion.