Magnetic Resonance Imaging Assessment of Velopharyngeal Motion in Chinese Children After Primary Palatal Repair

Tian, Wei; Li, Yang; Yin, Han; Zhao, Shouqin; Li, Sheng; Wang, Yan; Shi, Bing

doi:10.1097/scs.0b013e3181d08bee

Cited by 30 publications

(40 citation statements)

References 21 publications

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“…Few MRI studies of the velopharynx have examined the oblique coronal image plane (e.g., Kuehn et al, 2001; Ettema et al, 2002; Kuehn et al, 2004; Ha et al, 2007; Tian and Redett, 2009; Tian et al, 2010a, 2010b; Tian et al, 2010c; Bae et al, 2011; Perry, 2011; Perry et al, 2011). Prior to the use of 3D MRI sequences (Bae et al, 2011; Perry et al, in press-a), 2D acquisition along the length of the levator muscle required more time in the scanner and the levator muscle was more difficult to locate.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have examined the effectiveness of using MRI for assessing the structure and function of the levator muscle among adults with normal anatomy (Ettema et al, 2002; Tian and Redett, 2009; Bae et al, 2011; Perry, 2011; Perry et al, in press-a), adults with repaired cleft palate (Ha et al, 2007), children and infants with normal anatomy (Tian et al, 2010c; Perry et al, 2011; Perry et al, in press-b), children and infants prior to cleft palate repair (Tian et al, 2010b), and children after cleft palate repair (Kuehn et al, 2004; Perry et al, 2011). Studies have examined traditional image planes including sagittal, oblique, and axial (Akgüner et al, 1998; Özgür et al, 2000; Kane et al, 2002; Beer et al, 2004; Atik et al, 2008; Kao et al, 2008; Drissi et al, 2011; Silver et al, 2011).…”

mentioning

confidence: 99%

“…Analysis of the levator muscle using MRI in the oblique coronal image plane is critical in understanding the velopharyngeal mechanism. Studies have examined the oblique coronal image plane (e.g., Kuehn et al, 2001; Ettema et al, 2002; Kuehn et al, 2004; Ha et al, 2007; Tian and Redett, 2009; Tian et al, 2010a, 2010b; Tian et al, 2010c; Bae et al, 2011; Perry, 2011; Perry et al, 2011). …”

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confidence: 99%

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Sexual Dimorphism of the Levator Veli Palatini Muscle: An Imaging Study

Perry

Kuehn

Sutton

et al. 2014

The Cleft Palate Craniofacial Journal

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Objective Magnetic resonance imaging studies of the levator veli palatini muscle have used small numbers of subjects and have not consistently controlled for sex, race, or age. The purpose of this study was to conduct a structural assessment using a large homogeneous sample to examine the sex differences in the levator muscle morphology. Methods Thirty white adult subjects (15 men and 15 women) were imaged using a 3 Tesla MRI system. A high-resolution SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) sequence was used to acquire images of the velopharyngeal anatomy. Levator muscle measurements were obtained. Results Men displayed significantly greater levator extravelar segment length (P = .003), levator intravelar segment muscle length (P < .001), greater distance between levator insertion points (P < .001), and greater angles of origin (P= .008) compared with women. There was no statistically significant variation between men and women in the distance between points of origin at the base of the skull. Conclusions This study provides normative data to improve understanding of levator dysmorphology such as that in cleft palate muscle anatomy. Results of the study demonstrate significant differences between white men and women across several levator muscle measures. Variations in the relative size of the cranium or height of the individual were not proportionate to the variations observed in the levator muscle.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Sexual Dimorphism of the Levator Veli Palatini Muscle: An Imaging Study

Perry

Kuehn

Sutton

et al. 2014

The Cleft Palate Craniofacial Journal

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“…Comparisons between groups were performed since the VP muscles are contained within the cranium. Using methods previously described by Tian and Redett 10 and Tian et al, 8,11 cranial index measures were obtained, and no significant differences were noted between the cleft and noncleft groups.…”

Section: Methodsmentioning

confidence: 99%

Morphology of the Levator Veli Palatini Muscle in Adults With Repaired Cleft Palate

Kotlarek

Perry

Fang

2017

Journal of Craniofacial Surgery

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The purpose of this study was to examine differences in levator veli palatini (levator) morphology between adults with repaired cleft palate and adults with non-cleft anatomy. Fifteen adult participants (10 with non-cleft anatomy, 5 with repaired cleft palate) completed a 3D static MRI. Image analyses included measures of total muscle volume and the circumference and diameter at 6 points along the length of the muscle. Differences between groups were analyzed using independent sample Mann-Whitney U-Tests (α < 0.05). Significant differences between groups were noted for measures of muscle volume, circumference at the origin and insertion, anterior-posterior diameter at the origin and midline, and superior-inferior diameter at the point of insertion into the velum and midline. Differences in measures at other points along the levator muscle belly were not statistically significant. Limited sample size and gender differences may have impacted statistical findings. Overall, the levator muscle in adults with repaired cleft palate is significantly different than that of adults with non-cleft anatomy. This study demonstrates the successful implementation of a method for 3D analysis of velopharyngeal (VP) musculature with potential clinical utility given continued technological advancements in MRI. Continued evaluation of pre- and post-surgical anatomy and short- and long-term outcomes may contribute to a better understanding of the effects of various types of palatoplasties on levator structure, which is important to VP function for speech.

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“…Studies have suggested individuals with repaired cleft palate present with significantly thinner LVP muscle bundles. 18 Therefore, in addition to the possible dysmorphology or absence of the MU in cleft patients, it is important that consideration be given the functional significance of the MU as it relates to the effect on the nasal velar surface.…”

Section: Introductionmentioning

confidence: 99%

Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model

Inouye

Lin

Perry³

et al. 2016

Annals of Plastic Surgery

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The convexity of the dorsal surface of the velum is critical for normal velopharyngeal (VP) function and is largely attributed to the levator veli palatini (LVP) and musculus uvulae (MU). Studies have correlated a concave or flat nasal velar surface to symptoms of VP dysfunction including hypernasality and nasal air emission. In the context of surgical repair of cleft palates, the MU has been given relatively little attention in the literature compared with the larger LVP. A greater understanding of the mechanics of the MU will provide insight into understanding the influence of a dysmorphic MU, as seen in cleft palate, as it relates to VP function. The purpose of this study was to quantify the contributions of the MU to VP closure in a computational model. We created a novel 3D finite element model of the VP mechanism from MRI data collected from an individual with healthy non-cleft VP anatomy. The model components included the velum, posterior pharyngeal wall (PPW), LVP, and MU. Simulations were based on the muscle and soft tissue mechanical properties from the literature. We found that, similar to previous hypotheses, the MU acts as i) a space-occupying structure and ii) a velar extensor. As a space-occupying structure, the MU helps to nearly triple the midline VP contact length. As a velar extensor, the MU acting alone without the LVP decreases the VP distance 62%. Furthermore, activation of the MU decreases the LVP activation required for closure almost three-fold, from 20% (without MU) to 8% (with MU). Our study suggests that any possible salvaging and anatomical reconstruction of viable MU tissue in a cleft patient may improve VP closure due to its mechanical function. In the absence or dysfunction of MU tissue, implantation of autologous or engineered tissues at the velar midline, as a possible substitute for the MU, may produce a geometric convexity more favorable to VP closure. In the future, more complex models will provide further insight into optimal surgical reconstruction of the VP musculature in normal and cleft palate populations.

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Magnetic Resonance Imaging Assessment of Velopharyngeal Motion in Chinese Children After Primary Palatal Repair

Abstract: The VPI group had significantly reduced velar and pharyngeal mobility during speech compared with the VPC and noncleft groups. The possible physiological causes of VPI after primary palatal repair were discussed.

Cited by 30 publications

References 21 publications

Sexual Dimorphism of the Levator Veli Palatini Muscle: An Imaging Study

Sexual Dimorphism of the Levator Veli Palatini Muscle: An Imaging Study

Morphology of the Levator Veli Palatini Muscle in Adults With Repaired Cleft Palate

Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model

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