Incongruous Movements of the Velum and Lateral Pharyngeal Walls

Abstract

Five patients evaluated Via multi-view videofluoroscopy were found to have .ncongvruous movements between the velum and lateral aspects of the pharyngeal walls. All five patients had velopharyngeal insufi'z'ciency resulting from either absent lateral pharyngeal wall motion in the presence of velar mobility or absent velar mobility in the presence of lateral pharyngeal wall motion. The data indicates that these valving patterns are not rare phenomena of velopharyngeal valving. Treatment by pharyn— geal flap or other methods for velopharyngeal insufficiency must be suited to these peculiar valving patterns based on adequate diagnostic information. The physiology of velopharyngeal closure has been debated and questioned on numerous occasions and as is indicated by Dickson, et a1. (1974): " Opinions regarding the specific muscles responsible for these patterns of movement are almost as numerous as authors who discuss them (p. 477). " A multiplicity of explanations have been offered in discussing the posterosuperior movement of the velum and medial movements of the lateral pharyngeal walls during speech. There is general agreement that the levator muscle is responsible for observed velar mobility (Dickson, et al., 1974), but the muscles contributing to movements of the pharyngeal walls remain a point of contention. The purpose of this paper is to present some case reports of subjects who showed unusual patterns of velopharyngeal valving which raise questions concerning the physiology of velopharyngeal closure and methods for treating velopharyngeal insufficiency. It must be empha— sized that the multi-view videofluoroscopic data presented below do not answer any existing questions but may aid in constructing further hypotheses for future investigations. It has been well established that medial motion of the lateral pharyn— geal walls is essential to velopharyngeal closure (Calnan, 1953; Harring-Robert ]. Shprintzen, Ph.D., is Co—ordinator and