Preliminary exploration and reliability analysis of clinical diagnostic method for marginal velopharyngeal insufficiency

doi:10.7518/hxkq.2025.2024425

Abstract

Abstract:

Objective A stable, reliable, and easily implementable clinical diagnostic method for marginal velopharyngeal insufficiency (MVPI) was established on the basis of the subjective hearing judgement of hypernasality and objective examination of velopharyngeal closure to address the lack of unified diagnostic criteria for MVPI. Methods Nasopharyngeal fiberscopy and speech assessment results were collected from postoperative patients with cleft palate. These results were used to analyze the differences in the distribution of nasal resonance in patients with different velopharyngeal closure ratios and the correlation between velopharyngeal closure ratios and nasal resonance status. Mild-to-moderate hypernasality with its corresponding elopharyngeal closure ratio was employed to establish the diagnostic criteria of MVPI. The reproducibility of the criteria and whether the patients with MVPI diagnosed by using the criteria exhibited significantly different speech characteristics compared with other patients were verified. Results A strong correlation was found between velopharyngeal closure ratios and nasal resonance (P<0.001). Mild-to-moderate hypernasality mainly corresponded to velopharyngeal closure ratios ranging from 90% to 99%, and the combination of the two characteristics as the diagnostic criteria for MVPI demonstrated good consistency (Kappa value=0.789, P<0.001). Moreover, under the diagnostic criteria, significant differences in nasal resonance (P<0.001), nasal emission (P=0.007), and misarticulation (P<0.001) were found between patients with velopharyngeal insufficiency and those with MVPI. Conclusion Combining the subjective hearing judgement of mild-to-moderate hypernasality with velopharyngeal closure ratios over 90% under nasopharyngeal fiberscopy provides a reliable and effective clinical method for diagnosing MVPI.

Key words: velopharyngeal insufficiency, diagnosis, cleft palate, articulation

CLC Number:

R782.2^＋2

Huang Xinyi, Mao Qirong, Yin Heng, Wu Min, Shi Bing, Zheng Qian, Li Jingtao. Preliminary exploration and reliability analysis of clinical diagnostic method for marginal velopharyngeal insufficiency[J]. West China Journal of Stomatology, 2025, 43(3): 376-382.

Figures/Tables 8

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VCR/%	例数	比例/%
100	640	26.92
90~99	474	19.94
80~89	350	14.72
70~79	168	7.07
<70	745	31.34

鼻腔共鸣状态	例数	比例/%
无高鼻音	498	20.95
轻度高鼻音	428	18.01
中度高鼻音	237	9.97
重度高鼻音	1 214	51.07

鼻腔共鸣状态	VCR
鼻腔共鸣状态	100% （n=640）	90%~99% （n=474）	80%~89% （n=350）	70%~79% （n=168）	<70% （n=745）
无高鼻音	498/77.8	0/0	0/0	0/0	0/0
轻度高鼻音	135/21.1	291/61.4	2/0.6	0/0	0/0
中度高鼻音	5/0.8	101/21.3	90/25.7	35/20.8	6/0.8
重度高鼻音	2/0.3	82/17.3	258/73.7	133/79.2	739/99.2

VCR	两两比较的P值*
VCR	100%	90%~99%	80%~89%	70%~79%	<70%
100%	-	<0.001	<0.001	<0.001	<0.001
90%~99%	-	-	<0.001	<0.001	<0.001
80%~89%	-	-	-	1.000	<0.001
70%~79%	-	-	-	-	0.072

第一次评价	第二次评价			合计
第一次评价	VPI	MVPI	VPC	合计
合计	132	118	134	384
VPI	120	8	0	128
MVPI	12	96	20	128
VPC	0	14	114	128