Growth Effects on Velopharyngeal Anatomy From Childhood to Adulthood

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Objective: To identify quantitative and qualitative differences in the velopharyngeal musculature and surrounding structures between children with submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI) and noncleft controls with normal anatomy and normal speech. Methods: Magnetic resonance imaging was used to evaluate the velopharyngeal mechanism in 20 children between 4 and 9 years of age; 5 with unrepaired SMCP and VPI. Quantitative and qualitative measures of the velum and levator veli palatini in participants with symptomatic SMCP were compared to noncleft controls with normal velopharyngeal anatomy and normal speech. Results: Analysis of covariance revealed that children with symptomatic SMCP demonstrated increased velar genu angle (15.6°, P = .004), decreased α angle (13.2°, P = .37), and longer (5.1 mm, P = .32) and thinner (4 mm, P = .005) levator veli palatini muscles compared to noncleft controls. Qualitative comparisons revealed discontinuity of the levator muscle through the velar midline and absence of a musculus uvulae in children with symptomatic SMCP compared to noncleft controls. Conclusions: The levator veli palatini muscle is longer, thinner, and discontinuous through the velar midline, and the musculus uvulae is absent in children with SMCP and VPI compared to noncleft controls. The overall velar configuration in children with SMCP and VPI is disadvantageous for achieving adequate velopharyngeal closure necessary for nonnasal speech compared to noncleft controls. These findings add to the body of literature documenting levator muscle, musculus uvulae, and velar and craniometric parameters in children with SMCP.

Section: Statistical Analysesmentioning

confidence: 99%

Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study

Schenck

Perry

O'Gara

et al. 2020

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“…For example, the researcher can resample the data from an infinite number of image planes to capture other muscles that do not fall along the paths of the sampled image planes. The use of 3-D MRI data using alternate image planes has allowed investigations of muscles in vivo among individuals with and without cleft palate, such as the musculus uvulae and the tensor veli palatini (Bae et al, 2011; George et al, 2018; Perry et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Does the Type of MRI Sequence Influence Perceived Quality and Measurement Consistency in Investigations of the Anatomy of the Velopharynx?

Perry

Kotlarek

Chen

et al. 2021

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Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identifying key velopharyngeal landmarks, and reliability of making velopharyngeal measures between 3-dimensional (3-D) and 2-D magnetic resonance imaging (MRI) methods and between T1-, T2-, and proton density (PD)-weighted sequences. Methods: Twelve healthy participants completed an MRI study. Three raters assessed overall image quality and their ability to identify key anatomic features within the images. A single rater evaluated the reliability of making measures between imaging methods and sequence types to determine if image type (2-D and 3-D) or image sequence (T1, T2, PD weighted) resulted in different values for key velopharyngeal landmarks. Results: An analysis of variance test revealed image quality was rated significantly different based on the scan type ( P < .001) and the sequence used ( P = .015). Image quality was rated higher among 2-D MR images compared to 3-D, and higher among T2 sequences compared to T1- and PD-weighted imaging methods. In contrast, raters favored 3-D sequences over 2-D sequences for identifying velopharyngeal landmarks. Measures of reliability revealed scan type significantly impacted 2 of the 6 variables but to a minimal degree; however, sequence type had no impact on measures of reliability across all variables. Conclusion: Results of the study suggest the scan type and sequence used are factors that likely do not impact the reliability of measures. Based on image quality, the recommended technique for velopharyngeal imaging would be using a 2-D T2-weighted technique. However, based on the ability to identify key landmarks, a 3-D T1- or PD-weighted technique was favored.

“…When considering gender, females had higher nasalance scores on the /i/ sound and on nasal sounds as compared to males. This gender difference is likely due to sexual dimorphism of the velopharyngeal structures, particularly the velum, which reportedly is most evident after the age of 18 (Perry et al, 2019). As noted above, the velum in boys becomes significantly longer and thicker during puberty.…”

Section: Discussionmentioning

confidence: 99%

“…Significant differences in basic velar morphology have been found when comparing children with adults through magnetic resonance imaging studies (Kotlarek et al, 2019). In this line of research, Perry and colleagues found that during adolescence, particularly in boys, the length and thickness of the velum increases (Perry et al, 2018;Perry et al, 2019). As the velum becomes longer and thicker, this may cause increased impedance to the transmission of sound through the pharynx on nasal sounds, thus resulting in relatively lower nasalance scores on nasal sounds in adulthood.…”

Section: Effect Of Age and Gender On Nasalance Scoresmentioning

confidence: 99%

Nasalance Scores for Normal Speakers of American English Obtained by the Nasometer II Using the MacKay-Kummer SNAP-R Test

Alfwaress

Kummer

Weinrich

2021

Objective: To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II. Design: Prospective study using a randomly selected sample of participants. Setting: Greater Cincinnati area and Miami University of Ohio. Participants: Participants had a history of normal speech and language development and no history of speech therapy. Participants in the adolescent group were recruited from schools in West Clermont and Hamilton County, whereas the young adults were recruited from Miami University of Ohio. The participants of both groups were residents of Cincinnati, Ohio or Oxford, Ohio and spoke midland American English dialect. Outcome Measures: Mean nasalance scores for the SNAP Test-R. Results: Normative nasalance scores were obtained for the Syllable Repetition/Prolonged Sounds, Picture-Cued, and Paragraph subtests. Results showed statistically significant nasalance score differences between adolescents and young adults in the Syllable Repetition, Picture-Cued, and Paragraph subtests, and between males and females in the Syllable Repetition and the Sound-Prolonged subtests. A significant univariate effect was found for the syllables and sentences containing nasal consonants and high vowels compared to syllables and sentences containing oral consonants and low vowels. Across all the SNAP Test-R subtests, the females’ nasalance scores were higher than the males. A significant univariate effect was also found across nasal syllables, and high vowels such that the females’ nasalance scores were higher than the males. Tables of normative data are provided that may be useful for clinical purposes. Conclusion: Norms obtained demonstrated nasalance score differences according to age and gender, particularly in the Syllable Repetition/Prolonged Sound subtest. These differences were discussed in light of potential reasons for their existence and implications for understanding velopharyngeal function. In addition, nasalance scores are affected by the vowel type and place of articulation of the consonant. These facts should be considered when nasometry is used clinically and for research purposes.