My 3-year-old son is believed to have Veloparyngeal insufficiency. They want to do a nasalendoscopy on him but my husband is dead set against this and I was told he is too young and wouldn't tolerate it. I know there are other less invasive procedures out there but I'm having a hard time finding a speech language pathologist that can or will do them. Thanks for your input.

Velopharyngeal Incompetence is not an area I consider myself expert in, but it is a condition that is often associated with cleft palate and affects speech. Surgery is often needed to correct the problem.

Nasal endoscopy is actually not a difficult or dangerous procedure in most 3-year-old children, and I encourage you to continue to talk with your son's doctors about the risks and benefits of the procedure for your son. A less invasive approach might be to consider an MRI scan of the head and neck, though this procedure is also at least somewhat invasive in that a 3-year-old will often require some sort of sedation to stay still for this procedure. Another procedure that is not so invasive is called videoflouroscopy. Your doctors should be well aware of the full range of options and should be working with a multidisciplinary team to identify the procedure that makes most sense for your son. It may be that the best place to have this condition cared for would be in an academic center where many of these procedures are performed and where there is likely to be a wide range of tools to perform the appropriate assessment.

There was a very detailed article in December 2003 on this topic in the Journal of Plastic and Reconstructive Surgery. I am certain that your son's doctors could obtain a copy of it for you, if you'd like to review it in detail. Most important of all, I hope that as you push your doctors for more options that you will also remain open minded about what's best for your son. If he truly has a defect that needs surgical correction, it will be a good idea not to delay it too much. His speech development may depend on having something done about it sooner rather than later. Again, I say this knowing relatively little about your son's degree of impairment and the range of options available. And, as I tell all my patients who are not sure what to do for a complicated medical problem, a second opinion from another specialist can often help you figure out what is best.

All the best -- please let us know what you end up doing, and how it turns out.

Dr. Mike Potter

-- Michael Potter, MD, is an associate professor at the University of California at San Francisco Medical Center.

First published March 29, 2005
Last updated September 30, 2008
Copyright © 2005 Consumer Health Interactive