Normative Velopharyngeal Data in Infants

Abstract

Identifying normative data related to velopharyngeal muscles and structures may have clinical significance for infants born with cleft palate, especially as they relate to selection of surgical intervention and postsurgical outcomes. Previous studies suggest that patients whose anatomy postsurgically is dissimilar to that of their normative counterparts are at risk for hypernasal speech. However, studies have not documented what constitutes "normal" anatomy for the clinically relevant population-that is, the infant population. The purpose of this study is to examine a magnetic resonance imaging database (n = 29) related to normative velopharyngeal structures and provide a preliminary comparison to 2 selected patients with repaired cleft palate. Twenty-nine healthy infants between 9 and 23 months of age (mean = 15.2 months) with normal craniofacial and velopharyngeal anatomy were recruited to participate in this study. Normative data were compared to 2 infants with repaired cleft palate between 13 and 15 months of age (mean = 14 months). Quantitative craniometric and velopharyngeal measures from the sagittal and oblique coronal image planes were collected. Variables of interest included: levator muscle, velar, and craniometric measures. Females demonstrated significantly larger intravelar segments compared with males. White infants demonstrated significantly larger levator muscles compared to non-white infants. Infants with repaired cleft palate demonstrated increased overall levator muscle length and levator extravelar length compared with infants with normal velopharyngeal anatomy.Data from the present study provide a normative database for future investigators to utilize as a comparative tool when evaluating infants with normal and abnormal velopharyngeal anatomy.

Magnetic Resonance Imaging for Assessing Velopharyngeal Function: Current Applications, Barriers, and Potential for Future Clinical Translation in the United States

“…Thus far, as an imaging tool, MRI has been shown to be reliable, noninvasive, and provides both 2D and 3D views of key velopharyngeal musculature and structures, in both children and adults with cleft conditions. 11,21,22,48,[52][53][54][55][56][57] Furthermore, results of this study indicate that MRI is readily available and of interest for providers on cleft/craniofacial teams. Its use and acceptability, however, remain limited and dependent on the clinical situation in which it is being applied.…”

“…Normative anatomic measures, identified and obtained from MRI, have additionally been reported for varying patient populations. 10,21,[46][47][48][49][50] Additional translational research would likely help to bridge the reported research to practice gap that was noted in this survey and provide data for the efficacy of this modality for velopharyngeal assessments.…”

“…These findings suggest that currently published data pertaining to normative measures, indications for use, methodology, and interpretations of results have not yet translated to clinical practice. 10,11,14,[16][17][18]21,[38][39][40][41][42][43] A continued focus on practicebased research is likely to help facilitate the translation of these methods and research findings to clinical practice. 44 Further, many clinicians identified "sedation" or "anesthesia" as a barrier to using MRI for velopharyngeal assessments, indicating a potential procedural barrier.…”

“…As a result, many clinical implications for use of MRI with cleft and craniofacial diagnostics have been proposed. 10,[13][14][15][16][17][18][19][20][21][22][23][24][25] However, the use of MRI in the assessment process for children with cleft and craniofacial conditions remains uncommon in clinical practice on cleft and craniofacial teams, both in its general use by providers on craniofacial teams and particularly for velopharyngeal assessments. Specifically, there has been little systematic discussion of the barriers many clinicians may face when considering the implementation of MRI for clinical practice for this population of patients.…”

A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures

“…Secondary analysis of previously collected data was completed. Specifically, participants were recruited as part of separate studies including an infant magnetic resonance imaging (MRI) study (Schenck et al, 2016), a child MRI study (Perry, Kollara, et al, 2018), and an adult MRI study (Perry et al, 2016), all which were conducted for the purpose of analyzing the VP anatomy among a noncleft control group. In accordance with the local institutional review boards, 242 individuals between 4 months and 34 years of age were recruited to participate in this clinical MRI study.…”