Objective-Despite cleft palate repair, velopharyngeal competence is not achieved in ~15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resistant type 1 fibers. As an initial step to determining the validity of this theory, we tested the hypothesis that, in most cases, repair induces the transformation to type 1 fibers, thus diminishing susceptibility to injury.Interventions-Single permeabilized levator veli palatini muscle fibers were obtained from normal palates and nonrepaired congenitally-clefted palates of young (2 months old) and adult (14 to 15 months old) goats and from repaired palates of adult goats (8 months old). Repair was done at 2 months of age using a modified von Langenbeck technique.
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NIH-PA Author ManuscriptMain Outcome Measures-Fiber type was determined by contractile properties and susceptibility to injury was assessed by force deficit, the decrease in maximum force following a lengthening contraction protocol expressed as a percentage of initial force.Results-For normal palates and cleft palates of young goats, the majority of the fibers were type 2 with force deficits of ~40%. Following repair, 80% of the fibers were type 1 with force deficits of 20% ± 2%; these deficits were 45% of those for nonrepaired cleft palates of adult goats (p < .0001). (Elahi et al., 2004;Forrester and Merz, 2004; CDC, 2006). Following surgical repair, 10% to 20% of patients are still not able to achieve velopharyngeal closure (Marrinan et al., 1998), resulting in abnormal speech and other functional deficits that often necessitate secondary surgical correction. This outcome is typically a consequence of either inadequate palatal length or insufficient movement of the pharyngeal walls or soft palate. Soft palatal movement is dependent on the proper functioning of soft palate musculature (Kogo et al., 1996;Marrinan et al., 1998;Berry et al., 1999). Levator veli palatini (LVP; abbreviations listed in Table 1) muscle fibers from normal palates are aligned transversely across the posterior soft palate and when activated during velopharyngeal closure, retrodisplace and elevate the palate (Kogo et al., 1996;Marrinan et al., 1998;Berry et al., 1999). Impairment of LVP muscles of patients with cleft palates may contribute to the incidence of velopharyngeal dysfunction postrepair.
Conclusion-TheThe functionality of the LVP muscle is dependent on the fiber-type composition (Hanes et al., 2006; Rader et al., 2006). For normal palates of adult humans (Stal and Lindman, 2000;Lindman et al., 2001) and goats (Hanes et al., 2006; Rader et al., 2006), LVP muscles consist primarily of slow oxidative (type 1) fibers. In contrast, the LVP muscles in nonrepaired cleft palates are oriented in a longitudinal direction, abnormally insert on the posterior hard palate, and at least for adult goats, are predominantly...