Objective : The influence of gravity on the velopharyngeal structures in children is unknown. The purpose of this study is to compare the velopharyngeal mechanism in the upright and supine positions while at rest and during sustained speech production in children between 4 and 8 years old. Methods : A 0.6 Tesla open-type, multipositional magnetic resonance imaging scanner was used to image subjects in the upright and supine positions. The scanning protocol included a T2 fluid attenuation inversion recovery and an oblique coronal turbo spin echo scan with short scanning durations (7.9 seconds) to enable visualization of the velopharyngeal anatomy during rest and production of sustained /i/ and /s/. Results : The magnetic resonance imaging protocol used for this study enabled successful visualization of the velopharyngeal anatomy in the sagittal and oblique coronal planes at rest and during sustained phonation of /i/ and /s/. Positional differences demonstrated a small nonsignificant (P > .05) variation for velar measures (length, thickness, and height), retrovelar space, and levator veli palatini measures (length and angles of origin). Conclusions : Gravity had a negligible effect on velar length, velar thickness, velar height, retrovelar space, levator muscle length, and levator angles of origin. Supine imaging data can be translated to an upright activity such as speech. This is the first study to provide normative levator muscle lengths for children between 4 and 8 years old. Upright imaging may be a promising tool for difficult-to-test populations.

The purpose of this study was to quantify the growth of the various craniofacial and velopharyngeal structures and examine sex and race effects. Methods: Eight-five healthy children (53 white and 32 black) with normal velopharyngeal anatomy between 4 and 9 years of age who met the inclusion criteria and successfully completed the magnetic resonance imaging (MRI) scans were included in the study. Results: Developmental normative mean values for selected craniofacial and velopharyngeal variables by race and sex are reported. Facial skeleton variables (face height, nasion to sella, sella to basion, palate height, palate width) and velopharyngeal variables (levator muscle length, angle of origin, sagittal angle, velar length, velar thickness, velar knee to posterior pharyngeal wall, and posterior nasal spine to levator muscle) demonstrated a trend toward a decrease in angle measures and increase in linear measures as age increased (with the exception of posterior nasal spine to levator muscle). Only hard palate width and levator muscle length showed a significant sex effect. However, 2 facial skeleton and 6 velopharyngeal variables showed a significant race effect. The interactions between sex, race, and age were not statistically significant across all variables, with the exception of posterior nasal spine to posterior pharyngeal wall. Conclusion: Findings established a large age-and race-specific normative reference for craniofacial and velopharyngeal variables. Data reveal minimal sexual dimorphism among variables used in the present study; however, significant racial effects were observed.

Purpose: The purpose of this study is to examine craniometric and velopharyngeal anatomy among young children (4-8 years of age) with normal anatomy across Black and White racial groups. Method: Thirty-two healthy children (16 White and 16 Black) with normal velopharyngeal anatomy participated and successfully completed the magnetic resonance imaging scans. Measurements included 11 craniofacial and 9 velopharyngeal measures. Results: Two-way analysis of covariance was used to determine the effects of race and sex on velopharyngeal measures and all craniometric measures except head circumference. Head circumference was included as a covariate to control for overall cranial size. Sex did not have a significant effect on any of the craniometric measures. Significant racial differences were demonstrated for face height. A significant race effect was also observed for mean velar length, velar thickness, and velopharyngeal ratio. Conclusion:The present study provides separate craniofacial and velopharyngeal values for young Black and White children. Data from this study can be used to examine morphological variations with respect to race and sex.

Objective: The 22q11.2 deletion syndrome (22q11.2DS) is the most common genetic cause of velopharyngeal dysfunction; however, limited information exists regarding variations in velopharyngeal anatomy in this clinically challenging population. The purpose of this study was to examine velopharyngeal characteristics among young children with 22q11.2DS in comparison to a normative cohort using an innovative, nonsedated magnetic resonance imaging (MRI) scanning protocol. Methods: Fifteen children with 22q11.2DS and 15 age- and gender-matched controls with normal velopharyngeal anatomy (ages 4-12) successfully completed the MRI protocol. Eighteen velopharyngeal and 2 related craniofacial measures were examined. Analysis of covariance was used to compare differences between the experimental and the control groups. Results: The 22q11.2DS group demonstrated a significantly thinner velum ( P < .0005) and a larger pharyngeal depth ( P = .007) compared to the matched control group. Findings in the current study also demonstrated that the levator veli palatini muscle is significantly shorter ( P = .037) and thinner ( P = .025) in the 22q11.2DS cohort, with a significantly shorter origin-to-origin distance ( P < .0005) and a greater angle of origin ( P = .001) compared to healthy peers. Conclusion: Children with 22q11.2DS demonstrated multiple variations that may contribute to velopharyngeal dysfunction by altering the anatomic characteristics of the velopharyngeal port, the levator muscle, and associated structures. This investigation represents the first and largest attempt to characterize velopharyngeal anatomy in children with 22q11.2DS using a nonsedated MRI protocol.

The observed sexual dimorphism of velopharyngeal structures among adult populations has not been observed in the young child (4-to 9-year-old) population. The purpose of this study was to examine the age at which sexual dimorphism of velopharyngeal structures become apparent and to examine how growth trends vary between boys and girls. Method: Static 3-dimensional magnetic resonance imaging velopharyngeal data were collected among 202 participants ranging from 4 to 21 years of age. Participants were divided into 3 groups based on age, including Group 1: 4-10 years of age, Group 2: 11-17 years of age, and Group 3: 18-21 years of age. Nine velopharyngeal measures were obtained and compared between groups. Results: Significant sex effects were evident for levator length (p = .011), origin to origin (p = .018), and velopharyngeal ratio (p = .036) for those in Group 2 (11-17 years of age). Sex effects became increasingly apparent with age, with 7 of 9 variables becoming significantly different between male and female participants in Group 3. Boys, in general, displayed a delayed growth peak in velopharyngeal growth compared to girls. Conclusion: Results from this study demonstrate the growth of velopharyngeal anatomy with sexual dimorphism becoming apparent predominantly after 18 years of age. However, velopharyngeal variables displayed variable growth trends with some variables presenting sexual dimorphism at an earlier age compared to other velopharyngeal variables. N umerous studies have examined sex effects among velopharyngeal structures, particularly in the adult population. Perry, Kuehn, Sutton, Gamage, and Fang (2016) reported significant differences in velopharyngeal muscles and structures among 88 adults between 18 and 36 years of age. The authors found men demonstrated a significantly longer levator veli palatini (levator) muscle compared to women. The distance between the points where levator muscle inserts into the velar body (termed velar insertion distance) and distance between levator muscle origins was also significantly greater in men compared to women. Men were found to have a thicker and longer velum compared to women. Bae, Kuehn, Sutton, Conway, and Perry (2011) similarly reported among 10 adult participants (five men and five women) a significantly longer levator muscle among men compared to women. Perry, Kuehn, Sutton, and Gamage (2014) reported among 30 adult participants (15 men and 15 women) a significantly greater levator muscle length, greater distance between velar insertion points, and greater angles of origins. Literature supports the notion, however, that such sexual dimorphism is not found among children and may be associated with growth changes in late adolescence. Kollara, Perry, and Hudson (2016) examined 32 children between 4 and 8 years of age and did not observe sex differences in most velopharyngeal structures. Velar insertion distance was the only velopharyngeal variable found to vary based on sex, with boys demonstrating larger values than girls. A large-scale study including ...