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Assessment of velar and lateral wall movement by oral telescope and radiographic examination in patients with velopharyngeal inadequacy and in normal subjects.

Thirty-one patients referred to the Craniofacial Anomalies Clinic for speech evaluation were evaluated by endoscopy and cineradiographic examination (lateral and submentovertical projection). Movement of the velar and lateral walls was examined by both procedures in order to determine the accuracy of the endoscopy in assessing velopharyngeal movement. Cineradiography confirmed endoscopic observation in a large percentage of patients. In a second study, lateral wall motion was assessed in 20 cleft palate patients with repaired hard and soft palate but with velopharyngeal inadequacy. Four categories of closure defined in a previous study on normal subjects were used to classify lateral wall movement in the cleft palate patients. Mesial lateral motion past the sides of the velum during phonation occurred less frequently in patients with velopharyngeal inadequacy than in persons with normal strucutres. The absence of lateral wall motion was observed more often in the cleft palate patients, although in over half of these patients the lateral walls moved mesially and filled Rosenmuller's fossa (lateral recesses). Degree of lateral wall movement, which varies among cleft palate patients, should be estimated before construction of a prosthesis or pharyngeal flap in order to determine whether occlusion of the lateral gutters will occur during phonation.