title: Diagnosis and treatment of velopharyngeal insufficiency: clinical utility of speech evaluation and videofluoroscopy.
abstract: BACKGROUND
  The workup of velopharyngeal insufficiency (VPI) includes speech pathology evaluation and examination of velopharyngeal anatomy and physiology. This study sought to determine whether perceptual speech symptoms were predictive of velopharyngeal closure.
  
  
  METHODS
  A retrospective chart review of patients with VPI following primary palatoplasty was performed. All patients underwent perceptual speech evaluation using the Pittsburgh Weighted Speech Scale (PWSS) and examination of velopharyngeal anatomy by videofluoroscopy. PWSS scores were correlated to velopharyngeal closure.
  
  
  RESULTS
  All patients exhibited clinical VPI (PWSS = 5-27). No patient demonstrated complete velopharyngeal closure on videofluoroscopy. Velopharyngeal closure on the lateral view showed a statistically significant, moderate correlation with both the PWSS total score (rs = -0.424; P = 0.03) and the phonation subscore (rs = -0.405; P = 0.04).
  
  
  CONCLUSIONS
  Although certain aspects of speech are related to velopharyngeal anatomy, speech and videofluoroscopic studies each provide unique information in the workup of VPI. Selection of surgical approach often depends on anatomic factors, and improvement in speech postoperatively indicates successful treatment.
authors.affiliation: Division of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Dudas
authors.forename: Frederic W B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Ford
authors.forename: Shao
authors.initials: S
authors.lastname: Jiang
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis* / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000295:instrumentation*