Assessing VP function: the lateral still technique vs. cinefluorography

Thirty consecutive patients with clinical manifestations of velopharyngeal insufficiency were evaluated by the radiographic techniques of 70 mm lateral stills and lateral cinefluorography. The purpose of this study was to make retrospective comparisons between the actual decisions on velopharyngeal competency or incompetency which were originally made on the basis of cinefluorographic findings with those which we believe would have been made from that information obtained from lateral stills alone had the lateral stills been the only radiographic information available. The results of the comparison between the two techniques suggests that one is apt to misdiagnose the presence or absence of velopharyngeal insufficiency on the order of 30% of th time when relying on the lateral still X-ray technique alone. We attribute this potential error rate to the very limited speech sample that can be employed with the lateral still technique. With the increasing number of secondary procedures available for treating VP dysfunction it is our opinion that cine- or videofluoroscopy allows the clinician to examine additional aspects of the patient's palatal function that are as important in the final management decision as simply the identification of closure or the lack of closure of the velopharyngeal sphincter.