Kotlarek Katelyn J, Pelland Catherine M, Blemker Silvia S, Jaskolka Michael S, Fang Xiangming, Perry Jamie L
Division of Communication Disorders, University of Wyoming, Laramie.
Department of Biomedical Engineering, University of Virginia, Charlottesville.
J Speech Lang Hear Res. 2020 May 22;63(5):1317-1325. doi: 10.1044/2020_JSLHR-19-00240. Epub 2020 May 13.
Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( = .031) and effective velopharyngeal ratio ( = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( = .018), thickness at midline ( = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.
目的 本研究的目的是检查腭裂修复术后伴有腭咽闭合不全（VPI）的儿童、腭裂修复术后腭咽完全闭合的儿童以及非腭裂儿童的腭咽尺寸差异，以及腭帆提肌的形态、位置和对称性。方法 本研究招募了15名年龄在4至8岁之间的儿童。其中10名参与者有腭裂修复史，一半有记录的VPI，另一半腭咽闭合。从一个标准化数据库中匹配了5名年龄相仿的非腭裂儿童。磁共振成像方案、处理方法和分析与先前文献中使用的一致。结果 关于腭咽尺寸，矢状角（P = .031）和有效腭咽比（P = .013）的中位数在各组之间有统计学显著差异。关于腭帆提肌，平均腭外长度（P = .018）、中线厚度（P = .021）以及在插入软腭处左右肌束之间的厚度（P = .037）的中位数有统计学显著差异。其余测量结果无统计学显著差异。结论 这三组在腭帆提肌的中线厚度、腭外长度以及插入软腭处的对称性方面有显著差异。矢状角和有效腭咽比也有显著差异。腭裂修复术后伴有VPI的参与者表现出最大程度的不对称。未来的研究应控制手术程序类型，以确定手术对腭帆提肌和周围腭咽解剖结构的影响。
