The dynamics of Passavant's ridge in subjects with and without velopharyngeal insufficiency--a multi-view videofluoroscopic study.

Passavant's ridge was studied in 43 patients via multiview videofluoroscopy incorporating the simultaneous recording of speech. Ratings of the videotapes were made at full speed, in slowmotion, and by stop-framing. The following results were found: (1) Just as there are variable patterns of velopharyngeal closure, there were also variations in the way in which Passavant's ridge is positioned relative to the velum, and in the ridge's subsequent role in velopharyngeal narrowing or closure. (2) The ridge was the primary pharyngeal structure at the level of the velum that closed or locally narrowed the velopharyngeal portal in 37% of patients. (3) Passavant's ridge usually appeared as a structure encompassing both the lateral and posterior pharyngeal walls, and its presence was usually associated with active lateral pharyngeal wall motion. (4) Passavant's ridge was more prominent when the head was in the hyper-extended rather than the neutral position. (5) Passavant's ridge moved in a highly consistent manner, synchronous with velar movement.