Speaking and swallowing both rely on the physical separation of the of the oral and nasal cavities. The velopharyngeal valve consists of the soft palate (velum), and the side and back walls of the pharynx. The correct development of this valve separates the oral and nasal cavities, and any disorder that prevents its normal function is said to be a velopharyngeal dysfunction, or VPD.

Types of velopharyngeal dysfunction:

  • Velopharyngeal insufficiency is caused by an abnormal structure of the valve, typically related to an abnormality in the soft palate, and is common in children with cleft palate.
  • Velopharyngeal incompetence describes abnormal movement of the valve resulting from brain trauma or disorders.
  • Velopharyngeal mislearning refers to abnormal speech sound production when children make sounds in the pharynx rather than in the mouth.


Because VPD covers multiple types of dysfunctions, symptoms are diverse and may be detected at different developmental stages.

When velopharyngeal closure does not occur properly, food or excess air can escape through the nose. This can result in several speech disorders, such as hypernasal speech, inability to generate pressure for speech sounds, and/or inability to form speech sounds correctly due to leakage of air through the nose while speaking.

These dysfunctions also affect feeding, and symptoms often include leakage of food or liquid through the nose while eating.

Other symptoms may include cleft palate, submucous cleft palate, adenoidectomy, and tonsillectomy. VPD can also occur with other genetic conditions, such as velocardiofacial syndrome, neurofibromatosis, and Kabuki syndrome. Palatal tumors may also be present.


A speech language therapist and surgeon provide a diagnosis for your child through a speech examination and nasal imaging. Genetic tests, as well as sleep studies, may also be a part of the diagnosis.


Treatment depends on the type and cause of the dysfunction. The treatment of velopharyngeal insufficiency or velopharyngeal incompetence usually requires surgery to correct the structure or position of the valve. Speech therapy without surgery can often be used to treat velopharyngeal mislearning. Our interdisciplinary team at the North Carolina Cleft and Craniofacial Center can recommend and perform any further treatments for associated issues your child may have.