VELOPHARYNGEAL INCOMPETENCE AS THE PRESENTING SYMPTOM OF MALIGNANT BRAIN-STEM TUMOR

Objective: When a patient presents with velopharyngeal incompetence (V PI) without an obvious structural or neurologic cause, the clinician i s faced with a diagnostic challenge. We present an 11-year-old male wi th a long history of VPI who had been referred to our institution for evaluation and treatment. Results: Detailed clinical examination and w ork-up revealed a malignant brainstem tumor. The presenting symptoms o f breathiness associated with VPI had been overlooked by several diffe rent clinicians in the past, The patient successfully underwent a sphi ncter pharyngoplasty. Conclusions: A careful neurologic examination wi th special attention to the cranial nerves is necessary to identify su btle neurologic deficits and avoid delay in diagnosis. Differential di agnosis of neurogenic VPI is discussed.