Imaging the Velopharyngeal Sphincter in the Unrepaired Cleft Palate—Unopposed Musculus Uvulae Activity

In this report, the authors examine the case of a 28-year-old woman with an unrepaired isolated cleft palate, detailing her clinical evaluation and subsequent surgical management. Comprehensive evaluations included perceptual speech assessments, along with simultaneous nasendoscopy and lateral videofluoroscopy, allowing for a detailed analysis of the musculus uvulae and compensatory pharyngeal changes. The authors' findings revealed the unopposed action of the musculus uvulae, which, along with tongue positioning and a prominent Passavant’s ridge, contributed to a compensatory adaptation in the velopharyngeal area. Subsequent surgical interventions improved speech outcomes, demonstrating the value of a multidisciplinary approach in managing complex cases of unrepaired cleft palate.