The use and limitations of the barium pharyngogram in the detection of velopharyngeal insufficiency.

A barium pharyngogram was incorporated into the multiview videofluoroscopic evaluation of the velopharyngeal portal in 195 subjects in order to assess its usefulness in demonstrating competence or incompetence. Reflux of barium was always associated with a velopharyngeal gap and/or hypernasality; however, the absence of reflux was not similarly diagnostic. The pharyngogram proved to be useful in confirming the presence of a palatal or pharyngeal-flap fistula. While it is helpful in assessing velopharyngeal closure in selected cases, it should not be used in the absence of other information.