What procedure is best for diagnosing velopharyngeal dysfunction in a patient with flaccid dysarthria?

The best procedure for diagnosing velopharyngeal dysfunction in a patient with flaccid dysarthria is nasopharyngoscopy. This procedure allows for direct visualization of the velopharyngeal mechanism, including the movement of the soft palate, which is critical in assessing how well the velopharyngeal port is functioning. In cases of flaccid dysarthria, where muscle weakness can lead to inadequate closure of the velopharyngeal port, observing these structures in real-time provides valuable diagnostic information.

While the other procedures can be informative in different contexts:

• A videofluoroscopic swallow study focuses mainly on swallowing mechanics and may not provide the specific information about velopharyngeal closure needed in this case.

• A laryngoscopy examines the larynx and is primarily used for voice disorders rather than assessing velopharyngeal function.

• Manometry measures pressures within the swallowing system but does not visualize the anatomical structures involved in velopharyngeal closure.

Therefore, nasopharyngoscopy stands out as the most effective tool for diagnosing velopharyngeal dysfunction, particularly in the context of flaccid dysarthria.