Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA.
Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, Washington, USA.
Cleft Palate Craniofac J. 2024 Jul;61(7):1096-1103. doi: 10.1177/10556656231161991. Epub 2023 Mar 8.
To determine the sensitivity and specificity of velar notching seen on nasopharyngoscopy for levator veli palatini (LVP) muscle discontinuity and anterior positioning. Nasopharyngoscopy and MRI of the velopharynx were performed on patients with VPI as part of their routine clinical care. Two speech-language pathologists independently evaluated nasopharyngoscopy studies for the presence or absence of velar notching. MRI was used to evaluate LVP muscle cohesiveness and position relative to the posterior hard palate. To determine the accuracy of velar notching for detecting LVP muscle discontinuity, sensitivity, specificity, and positive predictive value (PPV) were calculated. A craniofacial clinic at a large metropolitan hospital.
Thirty-seven patients who presented with hypernasality and/or audible nasal emission on speech evaluation and completed nasopharyngoscopy and velopharyngeal MRI study as part of their preoperative clinical evaluation.
Among patients with partial or total LVP dehiscence on MRI, presence of a notch accurately identified discontinuity in the LVP 43% (95% CI 22-66%) of the time. In contrast, the absence of a notch accurately indicated LVP continuity 81% (95% CI 54-96%) of the time. The PPV for the presence of notching to identify a discontinuous LVP was 78% (95% CI 49-91%). The distance from the posterior edge of the hard palate to the LVP, known as effective velar length, was similar in patients with and without notching (median 9.8 mm vs 10.5 mm, = 1.00).
The observation of a velar notch on nasopharyngoscopy is not an accurate predictor of LVP muscle dehiscence or anterior positioning.
确定悬雍垂后缘切迹在评估软腭提肌（LVP）连续性中断和前移位中的敏感性和特异性。作为常规临床护理的一部分，对 VPI 患者进行了鼻咽镜检查和软腭磁共振成像（MRI）。两位言语病理学家独立评估了悬雍垂后缘切迹是否存在。MRI 用于评估 LVP 肌肉的凝聚力及其相对于后硬腭的位置。为了确定悬雍垂后缘切迹检测 LVP 肌肉连续性中断的准确性，计算了敏感性、特异性和阳性预测值（PPV）。一家大型都市医院的颅面诊所。
37 名患者在语音评估中表现出鼻音过高和/或可闻及的鼻音，并完成了鼻咽镜检查和软腭 MRI 研究，作为其术前临床评估的一部分。
在 MRI 上显示部分或完全 LVP 裂开的患者中，存在切迹可准确识别 LVP 中断 43%（95%CI 22-66%）的时间。相比之下，不存在切迹可准确指示 LVP 连续性 81%（95%CI 54-96%）的时间。切迹存在时识别不连续 LVP 的阳性预测值为 78%（95%CI 49-91%）。LVP 到硬腭后缘的距离，称为有效悬雍垂长度，在有或没有切迹的患者中相似（中位数 9.8 mm vs 10.5 mm，P=1.00）。
鼻咽镜检查中观察到悬雍垂切迹并不能准确预测 LVP 肌肉裂开或前移位。
