Patterns of velopharyngeal valving in normal and cleft palate subjects: a multi-view videofluoroscopic and nasendoscopic study.

The mechanism of velopharyngeal valving in normal subjects and patients with velopharyngeal insufficiency (VPI) has been the subject of keen debate. The authors have studied 80 normal subjects and 500 patients at the Center for Craniofacial Disorders using direct nasopharyngoscopy and multi-view videofluoroscopy to ascertain the patterns and mechanism of velopharyngeal valving. Multiple patterns of valving were found in both populations and were characterized as "coronal," "sagittal," "circular," and "circular with Passavant's ridge." The incidence of the differing patterns of closure were surprisingly similar in frequency in both normal and pathologic populations. The importance of these diagnostic methods is discussed in relation to treatment of patients with VPI, particularly in designing the type and level of pharyngoplasty.