Unresolved issues in velopharyngeal valving

Although technology for the study and assessment of velopharyngeal function has advanced, we continue to classify that function in simplistic categories: closure, borderline, and no closure. Many questions remain unanswered. Information is needed about the dimensions of closure including depth and orifice configuration as they relate to speech. Under what circumstances does hypernasality involve sound transmission through hypoplastic tissue? Is the configuration of the nasopharynx important to hypernasality? Tension in the speech mechanism and also developmental factors deserve study. Nonsurgical variables that might enhance velopharyngeal function are poorly understood. These and other issues and the means of their investigation are worthy of discussion in our professional forums.