2b Lateral radiograph pre and post sphincter pharyngoplasty Fig. The VPI developed as the adenoids became smaller. Postoperative radiograph of same patient. The lateral view during phonation is critical to placement of the sphincter pharyngoplasty at the appropriate height. Prosthetic and surgical methods are common.
Articulation is imprecise due to loss of oral pressure.
Misarticulations such as glottal stops cannot be corrected because of nasal air pressure loss. Speech is distorted from hypernasal distortions. A palatal lift is appropriate when the VPI is caused by poor movement of the velum. The anterior, retaining portion clasps to the teeth and a posterior tailpiece pushes the soft palate up into position to obturate the nasopharynx. A palatal obturator is appropriate when the VPI is caused by a deficiency in the length of the soft palate to close the velopharyngeal port.