Influence of tonsils on velopharyngeal movements in children with craniofacial anomalies and hypernasality.

Velopharyngeal activity and tongue and tonsil movements were examined cineradiographically in the connected speech of 40 hypernasal children with craniofacial disorders--20 with small tonsils and 20 with large tonsils. The tonsils were defined as large when they obstructed two thirds or more of the pharyngeal space; they were considered small if the obstruction was one fourth or less of the pharyngeal space. In patients with small tonsils, consistent velopharyngeal activity was seen most of the time, regardless of the position of the back of the tongue during speech. An association between large tonsils and decreased velopharyngeal activity was found for speech sounds articulated in the back of the mouth. Therefore when examining velopharyngeal activity in hypernasal children, it is important that the speech material include syllables and words with speech sounds articulated in the back of the mouth.