On the variability of velopharyngeal valve anatomy and function: a combined peroral and nasendoscopic study

The oropharynx stripped of the tonsils and the excessive mucosal folds after the uvulopalatopharyngoplasty operation allows a closed observation of the outline of the pharyngeal muscles. Forty-two consecutive patients undergoing uvolopalatopharyngoplasty were subjected to peroral examination of the oropharynx combined with nasendoscopic examination of the velopharyngeal valve. At rest, the oropharynx of the patients with coronal closure patterns was found to be flat relative to the oropharynx of the patients with the other closure patterns. During closure of the velopharyngeal valve, an anteroposterior movement of the velum, forming the nasendoscopic coronal closure pattern, was observed in patients with a flat oropharynx. On the other hand, a medial movement of the pharyngeal walls was found, forming the circular or sagittal closure pattern seen in patients with a deep oropharynx. Our conclusion is therefore that a different muscular orientation is responsible for both the different pharyngeal configuration at rest and the different contribution of the lateral and posterior pharyngeal walls to velopharyngeal valve closure.