Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study

Author:

Schenck Graham C.12ORCID,Perry Jamie L.3ORCID,O’Gara Mary M.45,Linde Amy Morgan67,Grasseschi Mitchell F.45,Wood Robert J.8,Lacey Martin S.910,Fang Xiangming11

Affiliation:

1. Department of Rehabilitation Therapies, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA

2. Department of Communication Sciences and Disorders, University of Wisconsin-River Falls, River Falls, WI, USA

3. Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA

4. Department of Pediatric Plastic Surgery, Shriners Hospital for Children-Chicago, Chicago, IL, USA

5. Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

6. Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA

7. Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo, MI, USA

8. Department of Plastic and Craniofacial Surgery, Banner Health System, Phoenix, AZ, USA

9. Department of Plastic Surgery, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA

10. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

11. Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA

Abstract

Objective: To identify quantitative and qualitative differences in the velopharyngeal musculature and surrounding structures between children with submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI) and noncleft controls with normal anatomy and normal speech. Methods: Magnetic resonance imaging was used to evaluate the velopharyngeal mechanism in 20 children between 4 and 9 years of age; 5 with unrepaired SMCP and VPI. Quantitative and qualitative measures of the velum and levator veli palatini in participants with symptomatic SMCP were compared to noncleft controls with normal velopharyngeal anatomy and normal speech. Results: Analysis of covariance revealed that children with symptomatic SMCP demonstrated increased velar genu angle (15.6°, P = .004), decreased α angle (13.2°, P = .37), and longer (5.1 mm, P = .32) and thinner (4 mm, P = .005) levator veli palatini muscles compared to noncleft controls. Qualitative comparisons revealed discontinuity of the levator muscle through the velar midline and absence of a musculus uvulae in children with symptomatic SMCP compared to noncleft controls. Conclusions: The levator veli palatini muscle is longer, thinner, and discontinuous through the velar midline, and the musculus uvulae is absent in children with SMCP and VPI compared to noncleft controls. The overall velar configuration in children with SMCP and VPI is disadvantageous for achieving adequate velopharyngeal closure necessary for nonnasal speech compared to noncleft controls. These findings add to the body of literature documenting levator muscle, musculus uvulae, and velar and craniometric parameters in children with SMCP.

Funder

Cleft Palate Foundation

National Institute on Deafness and Other Communication Disorders

Publisher

SAGE Publications

Subject

Otorhinolaryngology,Oral Surgery

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