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Velopharyngeal closure is essential for producing oral sounds in speech. The velopharyngeal mechanism is a muscular valve that separates the nasal and oral cavities. This mechanism involves several muscles, including the levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. The levator veli palatini muscle primarily accomplishes the velar component movement, while the palatoglossus and palatopharyngeus muscles fine-tune the velar position. The musculus uvulae fills the gap between the velum and the posterior pharyngeal wall. The palatopharyngeus muscle also raises the larynx and lowers the pharynx. The superior constrictor muscle produces a medial movement of the pharyngeal walls and assists in drawing the velum posteriorly. In some individuals, the Passavant ridge, composed of the uppermost fibers of the superior constrictor and palatopharyngeus muscles, may contribute to velopharyngeal closure.
| Characteristics | Values |
|---|---|
| What it is | Velopharyngeal closure (VPC) refers to the ability to seal the passage between the nasal and oral cavities. |
| When it occurs | During speech and swallowing, the velum elevates and is kept in a fully elevated position until it is lowered for breathing or nasal productions. |
| Control | VPC is a voluntary action controlled by the motor cortex. |
| Muscles involved | Levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. |
| Muscles that control the fine-tuning of velar position | Palatoglossus and palatopharyngeus. |
| Muscles that help in velar stretch and in filling the gap between the velum and PPW | Paired musculus uvulae. |
| Muscles that produce medial movement of the pharyngeal walls and assist in drawing the velum posteriorly | Superior constrictor. |
| Muscles that position the velum and narrow the velopharyngeal orifice by adducting the posterior pillars and constricting the pharyngeal isthmus | Palatopharyngeus. |
| Muscles that may contribute to velopharyngeal closure | Muscles that form the Passavant ridge: uppermost fibres of the superior constrictor and palatopharyngeus. |
| Dysfunction | Velopharyngeal dysfunction (VPD) is a broad term for the failure of the VPV to uncouple the nasopharynx and the oropharynx, resulting in hypernasal speech. |
| Causes of VPD | Velopharyngeal incorrect learning, velopharyngeal incompetence, and VPI. |
| Treatment of VPD | Speech therapy, surgical intervention, and/or prosthetic obturation. |
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What You'll Learn
The levator veli palatini muscle
The main action of the levator veli palatini muscle is the elevation of the soft palate. This action, together with the tensor veli palatini muscle, which tenses the soft palate, facilitates the act of swallowing by occluding the passage between the nasopharynx and oropharynx, preventing food from entering the nasopharynx. In addition to swallowing, the levator veli palatini muscle also participates in speech production. The velopharyngeal port must be closed during the production of all phonemes in the English language, except for the three nasal phonemes (/m/, /n/, /ng/).
Dysfunction of the velopharyngeal mechanism, including the levator veli palatini muscle, can lead to velopharyngeal insufficiency, incompetence, or mislearning. Insufficiency refers to structural defects that result in insufficient tissue for closure, such as a cleft palate. Incompetence describes impairment of motor control secondary to neurologic dysfunction, while mislearning results from factors independent of structural defects or neuromotor pathology. Assessment of velopharyngeal dysfunction includes a study of its degree and nature, and treatment options may include speech therapy, surgical intervention, or prosthetic obturation.
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Muscles involved in swallowing
Swallowing, also known as deglutition, is a complex motor skill that involves the coordination of over thirty muscles, the central nervous system, and five to six cranial nerves. It is a vital behaviour that humans learn very early in development, even as early as 15 weeks gestation to regulate amniotic fluid volume.
The process of swallowing involves muscles from the oral cavity, pharynx, larynx, and oesophagus. During the oral phase, the tongue and hard palate seal the bolus in the oral cavity for liquids. For solids, the bolus is formed in the oral cavity and propelled to the oropharynx, but it is not sealed. This allows for air to be pumped into the nasal cavity through the pharynx, delivering the aroma of the food to the chemoreceptors in the nose. The oral phase is followed by the pharyngeal phase, which begins when the bolus reaches the palatoglossal arch. This phase involves the tensor palatini and levator palatini, which elevate the soft palate to seal the nasopharynx and prevent pressure from escaping into the nasal cavity. The pharyngeal phase also involves the pharyngoesophageal muscles, which constrict to push the bolus into the oesophagus.
The palatopharyngeus and superior constrictor muscles are also involved in swallowing. The palatopharyngeus arises from the soft palate and inserts into the posterior border of the thyroid cartilage, narrowing the velopharyngeal orifice and raising the larynx. The superior constrictor arises from the lower portion of the pterygoid plate and hamular process and inserts into the median raphe, producing medial movement of the pharyngeal walls and assisting in drawing the velum posteriorly. The Passavant ridge, composed of the uppermost fibres of the superior constrictor and palatopharyngeus muscles, may also contribute to velopharyngeal closure during swallowing.
Swallowing difficulties can arise due to developmental delays or other disorders, and patients may undergo dysphagia rehabilitation to strengthen and improve the coordination of the swallowing muscles.
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Muscles involved in speech
The ability to speak clearly and intelligibly involves a diverse group of muscles, along with the brain and nervous system. The brain controls the muscles involved in speech through complex neural networks, with areas like Broca's area and Wernicke's area being responsible for language production and comprehension. The brain sends signals to the muscles, coordinating their movements to produce speech.
The diaphragm, vocal cords, tongue, lips, jaw, soft palate, and facial muscles are all essential for speech. The diaphragm helps to control the volume and clarity of speech by adjusting the tension of the vocal cords during exhalation. The vocal cords themselves, located in the larynx (voice box), are two bands of muscle that produce sound when air passes through them. By changing the tension and length of the vocal cords, different pitches and volumes can be created.
The tongue is another critical muscle for speech. Its versatility allows it to move in various directions to form different sounds. The lips, controlled by the orbicularis oris muscle, also play an important role in articulation and lip movements. The buccinator muscles in the cheeks help manage airflow and maintain cheek firmness, contributing to clear speech and expressive communication.
The soft palate, or velum, is positioned by the palatopharyngeus muscle, which also narrows the velopharyngeal orifice. The superior constrictor muscle, arising from the lower portion of the pterygoid plate and the hamular process, assists in drawing the velum posteriorly and producing medial movement of the pharyngeal walls. The Passavant ridge, composed of the uppermost fibres of the superior constrictor and palatopharyngeus muscles, may also contribute to velopharyngeal closure in some individuals.
Disorders or dysfunction affecting these muscles and structures can impact speech production. For example, dysarthria, resulting from neurological damage, can make it difficult to move the muscles involved in speech, leading to slurred or mumbled speech. Velopharyngeal dysfunction can encompass structural defects, such as cleft palate, or impairment of motor control secondary to neurologic dysfunction. Speech pathologists often provide targeted interventions and therapy to help individuals develop and improve their speech muscle control and articulation.
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Muscles involved in oral airflow
The human mouth is a complex system of muscles that work together to facilitate essential functions like speaking, eating, and expressing emotions. Oral airflow is a crucial aspect of speech production, and it involves the coordination of various oral and facial muscles.
During speech, the movements of the lips, tongue, and palate shape the airflow from the lungs into specific sounds, allowing us to communicate effectively. The orbicularis oris, a circular muscle surrounding the mouth, plays a role in controlling and shaping airflow during speech by puckering the lips and closing the mouth.
The palatopharyngeus muscle is another important muscle involved in oral airflow. It arises from the soft palate and affects the position of the velum, which is crucial for velopharyngeal closure during speech. The superior constrictor muscle also contributes to velopharyngeal closure and assists in drawing the velum posteriorly.
In addition to speech, oral airflow is also essential for chewing and swallowing. The masseter, temporalis, lateral pterygoid, medial pterygoid, and buccinator muscles are involved in mastication, or the chewing process. These muscles work together to break down food into smaller pieces and propel it towards the throat for swallowing.
The pharyngeal phase of swallowing is a complex process that involves the coordination of multiple muscles to prevent aspiration. During swallowing, the vocal cords come together, interrupting respiration. The pharyngeal constrictors, genioglossus, stylopharyngeus, and tensor veli palatini are among the muscles that help direct airflow and prevent food or liquid from entering the airway.
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Muscles involved in nasal airflow
The muscles involved in nasal airflow are those that affect the resonance of the nasal cavity, as well as those that are involved in velopharyngeal closure (VPC).
Nasal Airflow and Resonance
The nasal cavity is lined with mucous cells and respiratory epithelium. As air passes through the nasal cavity, it is warmed to body temperature and humidified. The neurovascular supply of this region helps to regulate nasal airflow by controlling blood volume in the erectile tissue on the inferior turbinate and anterior septum. The nasal septum is composed of cartilage and bone and is covered by squamous epithelium. A portion of the anterior septum is covered in erectile tissue, which can expand and contract to regulate airflow. The nasal cavity also contains olfactory receptors that detect and transmit signals for odour recognition.
Velopharyngeal Closure
VPC is an important part of speech production. All phonemes in the English language, except for the three nasal phonemes (/m/, /n/, /ng/), require oral airflow, meaning the velopharynx should be closed. The nasal phonemes, on the other hand, require the velopharynx to be open to produce nasal resonance. The palatopharyngeus and superior constrictor muscles are involved in VPC. The palatopharyngeus arises from the soft palate and inserts into the posterior border of the thyroid cartilage, helping to narrow the velopharyngeal orifice. The superior constrictor originates from the lower portion of the pterygoid plate and hamular process and assists in drawing the velum posteriorly. The Passavant ridge, composed of the uppermost fibres of these two muscles, may also contribute to VPC in some individuals.
Disorders Affecting Nasal Airflow
Disorders of the velopharyngeal sphincter mechanism, such as velopharyngeal insufficiency, incompetence, and mislearning, can lead to abnormal nasal airflow during speech. Cleft palate is a common congenital condition that can affect VPC, resulting in hypernasal speech. Other structural defects, neurologic dysfunction, or skull base surgery can also lead to velopharyngeal dysfunction.
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Frequently asked questions
The function of the velopharyngeal mechanism is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities for various purposes, including speech.
The muscles involved in velopharyngeal closure include the levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus.
The levator veli palatini muscle is primarily responsible for velar component movement, which is essential for velopharyngeal closure during speech.
Disorders associated with velopharyngeal closure include velopharyngeal insufficiency, incompetence, and mislearning. These can be caused by structural defects, neurologic dysfunction, or factors independent of defects or pathology.
Velopharyngeal closure is evaluated through perceptual and instrumental measures of velopharyngeal function, including nasoendoscopy and speech videofluoroscopy. Treatment options may include speech therapy, surgical intervention, or prosthetic obturation.
