A Unique Presentation of Velopharyngeal Dysfunction Secondary to Chiari I Malformation.

This article focuses on a case of velopharyngeal dysfunction (VPD) in an 8-year-old female, attributed to Chiari malformation type 1 (CM type 1), a condition characterized by downward herniation of the cerebellar tonsils through the foramen magnum causing brainstem compression. The patient exhibited severe hypernasality, a hypoplastic right hemi-velum, tongue atrophy, and an asymmetric velopharyngeal gap, with magnetic resonance imaging (MRI) confirming CM type 1 as the likely cause of cranial nerve dysfunction affecting velopharyngeal musculature. The report highlights the importance of including CM in the differential diagnosis of noncleft VPD, particularly when focal neurologic deficits or palatal asymmetries are present, and suggests that brain MRI can be a valuable diagnostic tool in such cases. While a direct causal relationship between CM and VPD remains unproven, neurosurgical evaluation and tailored surgical planning for VPD may benefit from recognizing this association.