Mason Kazlin N, Hanson Bailey, Black Jonathan S
From the Department of Human Services, University of Virginia, Charlottesville, Va.
Division of Plastic Surgery, University of Virginia Health System, Charlottesville, Va.
Plast Reconstr Surg Glob Open. 2024 Feb 19;12(2):e5617. doi: 10.1097/GOX.0000000000005617. eCollection 2024 Feb.
Advances in imaging tools provide opportunities to enhance how velopharyngeal (VP) variables are quantified to facilitate surgical decisions. The purpose of this study was to use magnetic resonance imaging (MRI) to determine if quantitative differences were present between measures of linear and curvilinear velar length, and subsequently, the VP needs ratio.
Data were prospectively collected from patients presenting with repaired cleft palate and/or congenital palatal insufficiency with or without VPI at a single center tertiary children's hospital. Quantitative measures of the velopharynx using a novel nonsedated MRI protocol were obtained. Paired samples tests were conducted to assess if differences were present between the VP needs ratio and measurements of linear and curvilinear velar length at rest and during sustained phonation. Intraclass correlation coefficients were calculated to assess intra/inter-rater reliability.
Significant differences were present between measurements of linear and curvilinear velar length at rest ( ≤ 0.001) and during sustained phonation ( ≤ 0.001). Significant differences were also present in the VP needs ratio ( ≤ 0.001). Curvilinear velar length at rest and during sustained phonation was longer than that of linear velar length at rest and during sustained phonation. No significant differences were observed between measures of effective velar length ( = 0.393).
Measurement differences influence the VP needs ratio. This may have implications for comparisons to previously reported normative reference values and for those who are anatomically at risk for VPI. MRI provides an enhanced imaging modality to assess normative benchmarks and the anatomic variables used to define VP anatomy for clinical decision-making.
成像工具的进步为改进腭咽（VP）变量的量化方式以辅助手术决策提供了机会。本研究的目的是使用磁共振成像（MRI）来确定直线型和曲线型腭长度测量值之间是否存在定量差异，以及随后的VP需求比率。
前瞻性收集来自一家单一中心的三级儿童医院中患有腭裂修复和/或先天性腭功能不全且伴有或不伴有VPI的患者的数据。使用一种新型的非镇静MRI方案获得腭咽的定量测量值。进行配对样本检验以评估VP需求比率与静止和持续发声时直线型和曲线型腭长度测量值之间是否存在差异。计算组内相关系数以评估评分者内/间信度。
静止时（≤0.001）和持续发声时（≤0.001）直线型和曲线型腭长度测量值之间存在显著差异。VP需求比率也存在显著差异（≤0.001）。静止和持续发声时曲线型腭长度均长于静止和持续发声时直线型腭长度。有效腭长度测量值之间未观察到显著差异（=0.393）。
测量差异会影响VP需求比率。这可能对与先前报道的标准参考值进行比较以及对那些在解剖学上有VPI风险的人有影响。MRI提供了一种增强的成像方式来评估标准基准以及用于定义VP解剖结构以进行临床决策的解剖学变量。
