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When we think about swallowing, we tend to think about the tongue and the pharyngeal muscles more so than we think about the velum. HOWEVER, the velum has an important role in swallow function. It's job is to elevate and approximate against the lateral and posterior pharyngeal walls, sealing off the nasal cavity. This in turn allows for an increase in pressure, which creates the force required to drive the bolus downwards into the pharynx and past the UES. If we note reductions/dysfunction in the velum's ability to properly seal off the nasal cavity then the patient may have VPD (Kummer, Marshall, & Wilson, 2015)" (Guyton K.,SandaM., Bailey D., Haak N., Molt L, and Plumb, A., 2018).
It is not often we see velopharyngeal dysfunction (VPD), but when we do it may have impacts on swallow function, which may include:
- Nasal Penetration - it is often associated with serious upper respiratory tract infections and cellulitis (Jang KW, Lee SJ, Kim SB, Lee KW, Lee JH, Park JG, 2019). Also, think about how it must feel for the patient to have food and liquid in their nasal cavity. It cannot be very comfortable.
- Reductions in Pressure to Drive Bolus Downward past UES which MAY Cause an Increase in Oropharyngeal Retention/Residues placing patient at risk for PENETRATION/ASPIRATION after the swallow
When we see VPD, we describe what we see and refer to an ENT. If the patient's issue is structural in nature, then medical intervention, such as surgery may be required. If it is an issue with function, then therapy may change abnormal functioning. Regardless, having a medical team (which includes the patient and/or POA) to help the patient navigate options is imperative.
If you suspect your patient is having issues with swallow function, IMAGING is the only way to know for sure what is going on.
To schedule an MBSS call our office at: 318.473.1978
REFERENCES:
Guyton K.,SandaM., Bailey D., Haak N., Molt L, and Plumb, A., 2018. Acquired Velopharyngeal Dysfunction: Survey, Literature Review, and Clinical Recommendations. American Journal of Speech-Language PathologyVolume 27, Issue 4 https://doi.org/10.1044/2018_AJSLP-17-0222
Jang KW, Lee SJ, Kim SB, Lee KW, Lee JH, Park JG. Effects of mechanical inspiration and expiration exercise on velopharyngeal incompetence in subacute stroke patients. J Rehabil Med. 2019 Feb 1;51(2):97-102. doi: 10.2340/16501977-2506. PMID: 30426133.
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