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Passavant's Ridge (Passavant's Pad) and Velopharyngeal Incompetence (VPI)

See: Velopharyngeal DiagnosticsCleft Lip and Palate Protocols

  • First described by Gustav Passavant in a cleft patient as an anterior displacement of the posterior pharyngeal wall contributing to velopharyngeal function (Passavant 1868).

  • Formed by superior pharyngeal constrictor muscle fibers creating a transverse fold/protrusion of tissue approximately ~5mm
  • Estimated to be present in approximately 11-30% of normal patients and approximately 9-41% of patients with cleft palate (Finkelstein 1993).
  • Thought to be of significance in patients with cleft palate and velopharyngeal insufficiency as a possible compensatory mechanism (Isberg et al. 1990).
  • Function remains poorly understood
    • May aid in preventing reflux of oropharyngeal contents into the nasopharynx (Yanagisawa 1996).
  • The contribution of Passavant's ridge to velopharyngeal insufficiency is debated
    • Some argue the ridge is too low, too slow, too inconsistent, and too easily fatigued to be of essential importance in the normal speech mechanism (Calnan 1954 and Calnan 1957).
    • Skolnick et al. argued that velopharyngeal competence relies on sphincteric movement with both velar and pharyngeal components
      • They showed that some individuals have more lateral pharyngeal wall motion than others, some have Passavant’s ridge, and that this variability of movement is true for both people with VPI and with normal velopharyngeal function.
      • Some patients with a marked deficiency in the velar component of velopharyngeal closure will exhibit an apparent compensatory increase in the movement of the pharyngeal component of closure, which in some cases can manifest as a development of Passavant's ridge (Skolnick 1973).

References

PassavantG, .: Uber die Verschlie~ungdesSchlundesbeim Sprechen.Virchows Arch. 46: 1-32 (1868)

Finkelstein YMD, Lerner MAMD, Ophir DMD, Nachmani AMA, Hauben DJMD, Zohar YMD. Nasopharyngeal Profile and Velopharyngeal Valve Mechanism. Plastic & Reconstructive Surgery. 1993;92(4):603-614.

Isberg AM, Henningsson GE. Intraindividual Change in the Occurrence of Passavant’s Ridge due to Change in Velopharyngeal Sphincter Function: A Videofluoroscopic Study. Cleft Palate Journal. 1990;27(3):253-257. doi:10.1597/1545-1569_1990_027_0253_icitoo_2.3.co_2

Yanagisawa E, Weaver EM. Passavant’s Ridge: Is It a Functional Structure? Ear Nose Throat J. 1996;75(12):766-767. doi:10.1177/014556139607501206

Calnan J. The Error of Gustav Passavant. Plastic and Reconstructive Surgery. 1954;13(4):275–289.

Calnan J. Modern views on passavant’s ridge. British Journal of Plastic Surgery. 1957;10:89-113. doi:10.1016/S0007-1226(57)80018-6

Skolnick ML, McCall GN, Barnes M. The Sphincteric Mechanism of Velopharyngeal Closure. The Cleft Palate Journal. 1973;10(3):286-305.