Plastic and Reconstructive Surgery

Velopharyngeal Dysfunction Program

Founded in 2011, the Velopharyngeal Dysfunction Program (or VPD Program) at The Children’s Hospital of Philadelphia offers coordinated treatment and ongoing care for patients diagnosed with velopharyngeal dysfunction (VPD). Velopharyngeal (veal-o-phar-in-geal) dysfunction includes the diagnosis of velopharyngeal insufficiency (VPI), submucous cleft palate and other related disorders.

Co-directed by the Division of Plastic and Reconstructive Surgery and the Department of Speech-Language Pathology, the VPD Program provides a comprehensive clinical evaluation in a single visit, starting with an assessment by a speech pathologist and a plastic surgeon.

Children with velopharyngeal dysfunction benefit from coordinated care that brings together all of the related specialties that may be needed to manage both the physical and functional aspects of the condition. This might include plastic surgery, speech pathology, audiology, psychology, genetics or radiology. The VPD Program works closely with the Cleft Lip and Palate Program, the Division of Otolaryngology (also known as Ear, Nose and Throat, or ENT), Genetics, and the Sleep Center in the Division of Pulmonology to manage your child’s care.

In addition to providing the best possible care for your child, we are committed to ongoing research that will improve outcomes and treatment options for children with VPD in the future. We collaborate with The Children’s Hospital of Philadelphia’s Division of Human Genetics and the 22q and You Center – the largest such center in the world – in ongoing efforts to improve standards of care for the management of VPD in patients with the 22q11.2 deletion syndrome.

What we treat

VPD causes complications with speech and swallowing due to abnormal function of the velopharyngeal valve, which includes the soft palate as well as the side and back walls of the throat. The purpose of these structures is to separate the oral and nasal cavities during swallowing and speech.

When velopharyngeal closure does not occur properly, food or excess air can escape through the nose. This can result in hypernasal speech, the inability to generate pressure for speech sounds, and the inability to form speech sounds correctly. These speech disorders can significantly interfere with your child’s ability to communicate effectively.

VPD can result from structural, neuromotor or other functional causes, and can occur in isolation or in conjunction with other medical or genetic conditions. The VPD Program treats patients with all forms of VPD.

Conditions treated in this clinic include VPD resulting from the following:

Your child’s evaluation

We treat children 3 1/2 years of age and older who have sufficient speech for a complete evaluation. Patients who are non-verbal may be cared for by other programs, such as the Cleft Lip and Palate Program or 22q and You Center, depending on their underlying condition.

During your child’s first visit, we will conduct a comprehensive clinical examination to get a thorough understanding of the condition and any potential complications, starting with assessments by a speech pathologist and a plastic surgeon.

Patients with VPD often require visualization and imaging of the velopharyngeal mechanism during speech. If needed, your child will undergo a structural evaluation of the velopharynx using video nasoendoscopy or, less often, videofluouroscopy. Our center is equipped with video nasoendoscopic equipment and can perform this study on the day of your visit. We will consult with the Department of Radiology to complete any additional visualization studies that may be needed.

After your child’s initial evaluation, our team will collaborate to determine the most appropriate timing and course of treatment. This may include specialized speech therapy, surgical intervention when indicated, psychosocial support, and consultation with a geneticist, neuropsychologist, developmental pediatrician or other specialists. Ongoing follow-up care is provided on a regular schedule. Team members are available to consult with local providers to optimize care for your child.

Appointments

Patients may be referred to the VPD Program by a variety of specialists. We frequently see children who are directed to our program by a speech pathologist, ENT specialist, geneticist or other clinicians.

If you have questions about treatment options and care provided by our program, a nurse coordinator will speak with you to gather information and determine the next steps for consultation or referral.

For more information about the VPD Program or to refer a patient, please call 215-590-2208 and ask to speak with Tikisha Elam or Meg Maguire.

Our team

Plastic Surgeons
Oksana A. Jackson, MD (Co-director)
Jesse A. Taylor, MD
David W. Low, MD

Speech Pathologists
Cynthia B. Solot, MA, CCC/SLP (Co-director)
Susan M. McCormack, MA, CCC/SLP

Genetics
Elaine H. Zackai, MD
Donna McDonald-McGinn, MS, CGC

Psychology
Leanne Magee, PhD

Social Work
Kim St. Lawrence, MSW

Nurse Practitioner
Meg Ann Maguire, RN, MS, CRNP, CPNP

 

Updated January 2014

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