الفهرس 
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Abstract
Summary
Velopharyngeal insufficiency (VPI) is known as a failure of the separation between nose and mouth, because of an anatomical dysfunction of the soft palate, the lateral or posterior wall of the pharynx.
The effect of such a dysfunction leads to functional problems with speech(hypernasality), eating and breathingThis gap can be treated surgically, although the operational technique which should be used is still controversial. The main object is to visualize the preoperative velopharyngeal dimensions and movements and adjust your postoperative goal upon these results. There are different diagnostic tools which can help visualize these movements and dimensions..
The terms velopharyngeal ”incompetence”, ”inadequacy” and ”insufficiency” historically have been used interchangeably, although they do not necessarily mean the same thing. Velopharyngeal insufficiency includes any structural defect of the velum or pharyngeal walls at the level of the nasopharynx with insufficient tissue to accomplish closure, or there is some kind of mechanical interference with closure. It is important that the term insufficiency is used if it is an anatomical defect and not a neurological problem.
Velopharyngeal insufficiency (VPI) can be caused by a variety of disorders (structural, genetic, functional or acquired) and is very often associated with a cleft palate. Abnormal physiological separation of the oropharynx from the nasopharynx can lead to VPI and hypernasality.
Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating velopharyngeal dysfunction. Although not in all patients complete closure will be achieved after the surgical procedures, they do show a reduction of the size of the velopharyngeal defect. The planning of the surgical procedure seems to be the most important aspect of the surgery for correcting velopharyngeal dysfunction. To clarify the problems of each individual patient, diagnosis will be confirmed by hearing (speech analysis) and imaging (videofluoroscopy and nasoendoscopy) the defect. It is important to think about that these different diagnostic procedures can give a various result, because of the fact that what you hear does not necessarily correlate with what is seen.
The preoperative planning will give you important information about the movement of the soft palate, the lateral pharyngeal walls and posterior pharyngeal wall. The part of the soft palate with the maximal movement, gives you the precise level where tissue has to be attached. This information decides the length of the pharyngeal flap or lateral flaps. Likewise, the size and shape of the gap is considered for determining the width of the pharyngeal flap or lateral flaps. The dissymmetry will be corrected by placing an asymmetric flap or creating unilateral a wider flap in the sphincteroplasty procedure. This is why diagnostic tools contribute immensely in the approach of the problem, and consequently decide if the operation can be called a success Moreover, it is concluded that the diagnostic tool that should be used has to be chosen on the aspect of the velopharyngeal defect of the individual