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Abstract

Objective

When a patient presents with velopharyngeal incompetence (VPI) without an obvious structural or neurologic cause, the clinician is faced with a diagnostic challenge. We present an 11-year-old male with a long history of VPI who had been referred to our institution for evaluation and treatment.

Results

Detailed clinical examination and work-up revealed a malignant brain-stem tumor. The presenting symptoms of breathiness associated with VPI had been overlooked by several different clinicians in the past. The patient successfully underwent a sphincter pharyngoplasty.

Conclusions

A careful neurologic examination with special attention to the cranial nerves is necessary to identify subtle neurologic deficits and avoid delay in diagnosis. Differential diagnosis of neurogenic VPI is discussed.

Keywords

glioma hypernasality neurogenic VPI neuromotor VPI sphincter pharyngoplasty velopharyngeal insufficiency (VPI)vocal fold paralysis

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