Growth Effects on Velopharyngeal Anatomy Within the First 2 Years of Life.

PURPOSE: Limited quantitative data exist regarding growth of the velopharynx within the first 2 years of life. The purpose of this study was to (a) quantify changes in velopharyngeal structures due to growth during the first 2 years of life, (b) examine the impact of sex and race within this age range, and (c) provide normative measures for comparison to individuals with cleft palate. METHOD/DESCRIPTION: A retrospective chart review was completed of all patients up to 24 months of age that underwent magnetic resonance imaging of the head for medical necessity within the past 18 months using a three-dimensional fluid-attenuated inversion recovery sequence. Measurements of the velopharynx were obtained from 200 scans consistent with previous literature. Participants were divided into five groups based on corrected age for comparison. Variables of interest included adenoid depth, angle of origin, effective velopharyngeal ratio, effective velar length, levator veli palatini length, origin-origin distance, pharyngeal depth, sagittal angle, velopharyngeal ratio, velar insertion distance, velar length, and velar thickness. RESULTS: Velopharyngeal dimensions were significantly different among corrected age groups after controlling for sex and race. Regarding age, analyses revealed significant differences in all variables of interest except effective velopharyngeal ratio. Regarding sex, significant differences were observed for angle of origin, effective velopharyngeal ratio, effective velar length, levator veli palatini muscle length, and velar insertion distance. Regarding race, a significant difference was only observed for angle of origin. CONCLUSIONS: Results of this study demonstrate growth of velopharyngeal anatomy in normative infants with race and sex effects apparent in children up to 24 months of age. Variable growth trends were observed among different velopharyngeal measures.

Functional analysis of the rat soft palate by real-time wireless electromyography.

OBJECTIVE: The aim of this study was to analyze the function of the palatal muscles in vivo by real-time wireless electromyography in rats. The effects of palatal wounding were also analyzed. METHODS: Microelectrodes were implanted six rats; in the masseter muscle (two-rats) for comparison, in the unwounded soft palate (two-rats) and the soft palate that received a surgical wound (two-rats). Two weeks after implantation, a wound was made in the soft palate using a 1 mm biopsy-punch. Electromyographic measurements and video-recordings were taken weekly to monitor train-duration and peak-amplitude during eating, grooming and drinking. RESULTS: The train-duration of the masseter muscle during eating was 0.49 ±â€¯0.11 s (rat-1) and 0.56 ±â€¯0.09 s (rat-2), which was higher than during grooming. In the unwounded soft palate the train-duration during eating was 0.63 ±â€¯0.12 s (rat-1) and 0.69 ±â€¯0.069 s (rat-2), which was higher than during grooming and drinking. The peak-amplitude for eating in the normal soft palate before surgery was 0.31 ±â€¯0.001 mV (rat-1) and 0.33 ±â€¯0.02 mV (rat-2). This decreased to 0.23 ±â€¯0.03 mV and 0.25 ±â€¯0.11 mV respectively, after surgery. For drinking the peak-amplitude was 0.30 ±â€¯0.01 mV (rat-1) and 0.39 ±â€¯0.01 mV (rat-2) before surgery, which decreased to 0.23 ±â€¯0.09 mV and 0.20 ±â€¯0.14 mV respectively, after surgery. CONCLUSION: The reduced peak-amplitude suggests impaired soft palate function after wounding. This is the first study into the in vivo function of the soft palate after surgical wounding. This model will contribute to develop strategies to improve soft palate function in patients.

Postoperative Skeletal Stability and Pharyngeal Airway: Counterclockwise versus Clockwise Rotation during Mandibular Setback Surgery.

PURPOSE: To compare the effects of counterclockwise rotation (CCR) and clockwise rotation (CR) of the mandible on the pharyngeal airway during mandibular setback surgery. Materials and Methods. Serial cephalograms of 40 patients with mandibular prognathism, including 20 who underwent CCR and 20 who underwent CR, were taken at the following time intervals: preoperatively (T1), immediately postoperatively (T2), >1 year after surgery (T3), final surgical changes (T31), postoperative stability (T32), and immediate surgical change (T21). Changes in menton (Me) and hyoid (H) positions, soft palate width, soft palate length, soft palate angle and craniovertebral angle (C2C4-SN), and pharyngeal airway spaces (nasal pharyngeal airway (NOP), uvula pharyngeal airway (UOP), tongue pharyngeal airway (TOP), and epiglottis pharyngeal airway (EOP)) were evaluated. RESULTS: The mean Me (T31) setback for CCR and CR was 12.56 and 13.06 mm, respectively, with 2.41 mm upward and 3.29 mm downward, respectively. The vertical Me position of CR exhibited significant downward movement compared with that of CCR. The mean H setback results for CCR and CR were 4.42 and 5.75 mm, respectively, with 1.47 mm downward and 2.97 mm downward, respectively. The C4C2-SN angles for CCR and CR increased by 2.68° and 3.65°, respectively, whereas their palatal angles increased by 2.35° and 5.25°, respectively. Pearson's correlation analysis (T31) revealed that for CCR, no pharyngeal airway spaces were significantly correlated with any measured variables. In CR, NOP was significantly correlated (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (. CONCLUSION: Pharyngeal airway space narrowed postoperatively, and its patency was appropriately maintained through natural physiological regulation of the craniovertebral angle (C2C4-SN). Significant postoperative relapse was correlated with CR.

Abnormalities of the muscles of the soft palate and their impact on auditory function in patients operated on for cleft palate: a case-control study.

Patients with cleft palate have a high incidence of otitis media (OM), which, even after palatal repair, can persist and lead to auditory dysfunction. We aimed to identify what predisposes such patients to develop OM and correlate it with auditory function. We designed a prospective case-control study of adults who had had their cleft palates repaired in childhood. We examined the anatomy of the eustachian tube and the paratubal muscles of the soft palate with magnetic resonance imaging (MRI), assessed auditory function, and correlated the results to evaluate the impact of the pathological anatomy on the function of the middle ear. A total of 64 ears in 32 patients were evaluated (Group A, n = 16) (Group B, controls = 16). MRI showed a short eustachian tube with a shortened tensor attachment in Group A when compared with Group B. The pterygoid hamulus was found to be intact in both groups, but extensive perihamular fibrosis was seen in Group A. A total of 15 ears in Group A had loss of hearing (prevalence ratio (PR) 1.08), (13 mild loss, and 2 moderate loss), and impedance audiometry showed effusion of the middle ear in 12 ears in 16 patients, and dysfunction of the eustachian tube with high negative pressure in the middle ear in four ears in the 16 patients (PR 4.6). These could be positively correlated with the pathological anatomy using Pearson's correlation coefficient. Otitis media is persistent and can lead to conductive hearing loss in adults who have been operated on for cleft palate. This can be attributed to abnormalities in the development of the eustachian tube and the paratubal musculature.

Analysis of Velopharyngeal Functions Using Computational Fluid Dynamics Simulations.

OBJECTIVES: Competent velopharyngeal (VP) function is the basis for normal speech. Understanding how VP structure influences the airflow during speech details is essential to the surgical improvement of pharyngoplasty. In this study, we aimed to illuminate the airflow features corresponding to various VP closure states using computed dynamic simulations. METHODS: Three-dimensional models of the upper airways were established based on computed tomography of 8 volunteers. The velopharyngeal port was simulated by a cylinder. Computational fluid dynamics simulations were applied to illustrate the correlation between the VP port size and the airflow parameters, including the flow velocity, pressure in the velopharyngeal port, as well as the pressure in oral and nasal cavity. RESULTS: The airflow dynamics at the velopharynx were maintained in the same velopharyngeal pattern as the area of the velopharyngeal port increased from 0 to 25 mm2. A total of 5 airflow patterns with distinct features were captured, corresponding to adequate closure, adequate/borderline closure (Class I and II), borderline/inadequate closure, and inadequate closure. The maximal orifice area that could be tolerated for adequate VP closure was determined to be 2.01 mm2. CONCLUSION: Different VP functions are of characteristic airflow dynamic features. Computational fluid dynamic simulation is of application potential in individualized VP surgery planning.

Species generalization and differences in Hedgehog pathway regulation of fungiform and circumvallate papilla taste function and somatosensation demonstrated with sonidegib.

Species generalization in the profound, modality-specific effects of Hedgehog pathway inhibition (HPI) in taste organ homeostasis and sensation is shown. With the HPI, cancer drug sonidegib, we demonstrate that the rat taste system, in addition to mouse, is regulated by Hedgehog signaling. After sonidegib treatment for 16-36 days in rat, there is loss of taste buds (TB) in soft palate, in fungiform (FP) and circumvallate papillae (CV), and elimination of taste responses from chorda tympani and glossopharyngeal nerves. The retained innervation in FP and CV during HPI cannot sustain TB. Responses to tactile stimuli are not altered, and temperature responses are reduced only after 28 days treatment, demonstrating modality-specific effects. Rat FP and neural effects are similar to those in mouse whereas TB and neural response effects from the rat CV are much more severe. When recovery is introduced in mouse after prolonged, 48 days HPI, the TB in CV are restored whereas those in FP are not. Overall, Hedgehog signaling regulation is shown to generalize to the rat taste system, and the modality-specific controls in taste organ sensation are affirmed. The reported, debilitating taste disturbances in patients who use HPI drugs can be better understood based on these data.

Biomechanics of the soft-palate in sleep apnea patients with polycystic ovarian syndrome.

Highly compliant tissue supporting the pharynx and low muscle tone enhance the possibility of upper airway occlusion in children with obstructive sleep apnea (OSA). The present study describes subject-specific computational modeling of flow-induced velopharyngeal narrowing in a female child with polycystic ovarian syndrome (PCOS) with OSA and a non-OSA control. Anatomically accurate three-dimensional geometries of the upper airway and soft-palate were reconstructed for both subjects using magnetic resonance (MR) images. A fluid-structure interaction (FSI) shape registration analysis was performed using subject-specific values of flow rate to iteratively compute the biomechanical properties of the soft-palate. The optimized shear modulus for the control was 38 percent higher than the corresponding value for the OSA patient. The proposed computational FSI model was then employed for planning surgical treatment for the apneic subject. A virtual surgery comprising of a combined adenoidectomy, palatoplasty and genioglossus advancement was performed to estimate the resulting post-operative patterns of airflow and tissue displacement. Maximum flow velocity and velopharyngeal resistance decreased by 80 percent and 66 percent respectively following surgery. Post-operative flow-induced forces on the anterior and posterior faces of the soft-palate were equilibrated and the resulting magnitude of tissue displacement was 63 percent lower compared to the pre-operative case. Results from this pilot study indicate that FSI computational modeling can be employed to characterize the mechanical properties of pharyngeal tissue and evaluate the effectiveness of various upper airway surgeries prior to their application.

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

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 3-dimensional (3D) finite element model of the VP mechanism from magnetic resonance imaging data collected from an individual with healthy noncleft 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 3-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.

Posterior Pharyngeal Flap for Velopharyngeal Insufficiency Patients: A New L-Shaped Flap.

OBJECTIVE: To describe and assess the results of central inset L-shaped posterior pharyngeal flap (PF) for treatment of velopharyngeal incompetence. METHODS: This study included 12 patients who were diagnosed as persistent velopharyngeal insufficiency. L-shaped central inset superiorly based PF was harvested from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm behind the posterior margin of the hard palate, then the flap was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate. Before and after surgery, patients were assessed by examination, video: nasoendoscopy, and speech assessment. RESULTS: Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported. CONCLUSIONS: The new used L-shaped PF could properly correct velopharyngeal functions (closure and speech) in patients with persistent velopharyngeal insufficiency with no reported complication.

Sphincterplasty for Velopharyngeal Insufficiency in the Child Without a Cleft-Palate: Etiologies and Speech Outcomes.

The aim of this study is to report on speech outcomes following surgery for velopharyngeal insufficiency (VPI) on a broad spectrum of patients without a cleft palate. Inclusion criteria included patients without a cleft palate operated on by a single surgeon (JKW) over a 10-year period and postoperative speech evaluation within 1 year. All patients underwent a sphincter pharyngoplasty. The main outcome measures were perceptual speech assessment using a 6-point scale (1 = none or normal, 6 = severe); velopharyngeal function (VPF) (1 = adequate, 2 = marginal, 3 =  dequate); and quantitative nasalance score. Forty children (mean age 7.5 y) were included. Eight unique conditions were identified; the most common was 22q deletion syndromes (27.5%). All patients had a deep nasopharynx, mean nasopharyngeal depth >0.67. Two novel cases are presented in each child with mosaic Trisomy 14 and ring chromosome 18 abnormality. Of all patients, 87.5% improved their postoperative hypernasality score. Preoperatively, all patients had either marginal or inadequate VPF (2 or 3). Postoperatively, 90% of patients (n = 36) achieved adequate velar function, the remainder did not improve at the first postoperative evaluation. Intelligibility and audible nasal emissions improved in between 57% and 65% of patients. Articulation proficiency was the only perceptual rating not to improve initially, but then did so on the most recent postoperative speech evaluation. This study demonstrates successful speech outcomes in a diverse group of patients. It also increases awareness of noncleft VPI amenable to surgical correction.

Isolation and Characterization of Satellite Cells from Rat Head Branchiomeric Muscles.

Fibrosis and defective muscle regeneration can hamper the functional recovery of the soft palate muscles after cleft palate repair. This causes persistent problems in speech, swallowing, and sucking. In vitro culture systems that allow the study of satellite cells (myogenic stem cells) from head muscles are crucial to develop new therapies based on tissue engineering to promote muscle regeneration after surgery. These systems will offer new perspectives for the treatment of cleft palate patients. A protocol for the isolation, culture and differentiation of satellite cells from head muscles is presented. The isolation is based on enzymatic digestion and trituration to release the satellite cells. In addition, this protocol comprises an innovative method using extracellular matrix gel coatings of millimeter size, which requires only low numbers of satellite cells for differentiation assays.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults / Relação entre as avaliações clínica e instrumental da língua em adultos jovens

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks. .

OBJETIVO: Pesquisar a associação entre os aspectos da avaliação clínica da língua e avaliação quantitativa da força de protrusão da língua. Métodos: Foi realizada uma pesquisa transversal com 48 adultos saudáveis, 13 homens e 35 mulheres (idades entre 20 e 44 anos; média - M=24,8 anos; desvio padrão - DP=5,3 anos). Na avaliação clínica, os seguintes aspectos foram avaliados: força da língua, movimentos alternados, estalo, sucção e vibração da língua. O avaliador também verificou se o assoalho da boca elevava-se durante tarefas de elevação e sucção de língua no palato, bem como a ocorrência de tremor lingual. Para avaliação quantitativa da força da língua, utilizou-se o FORLING, o qual é composto por um conjunto pistão/cilindro acoplado a um bocal e a uma haste de acionamento. A força aplicada pela língua à haste é hidraulicamente transmitida a um sensor de pressão. Utilizou-se o teste de Mann-Whitney para verificar se havia diferenças nas forças médias e máximas, de acordo com as características avaliadas. Adotou-se nível de significância de 5%. RESULTADOS: Os aspectos com maior número de indivíduos alterados foram sucção de língua no palato e vibração de língua. Tremor lingual teve alta ocorrência durante tarefas de mobilidade. Elevação do assoalho da boca durante sucção de língua no palato foi o único aspecto da avaliação clínica associado à avaliação quantitativa de força. CONCLUSÃO: A associação entre elevação do assoalho da boca durante sucção de língua no palato com a avaliação quantitativa de força pode indicar uma maior participação da musculatura supra-hióidea em determinados participantes em ambas as tarefas. .

Anatomy and physiology of velopharyngeal closure and insufficiency.

The velopharynx is a complex structure that is responsible for separation of the oral and nasal cavities during speech production and swallowing. Incompetence of this mechanism can lead to hypernasality, with nasal air emission and incomprehensible speech, as well as nasopharyngeal regurgitation. There can be a significant social stigma associated with velopharyngeal dysfunction, and surgical treatment can be curative in many cases. Knowledge of the normal anatomy and physiology of the velopharyngeal complex is essential when planning for surgical repair.

Evaluation of velopharyngeal closure by 4D imaging using 320-detector-row computed tomography.

OBJECTIVE: Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palate patients based on dynamic volume scanning with 320-detector-row CT. METHODS: Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. RESULTS: 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. CONCLUSIONS: 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.

Quantitative description of eustachian tube movements during swallowing as visualized by transnasal videoendoscopy.

IMPORTANCE: Eustachian tube (ET) dysfunction predisposes ears to otitis media, tympanic membrane retraction, retraction pocket and perforation, or cholesteatoma. OBJECTIVE: To develop a method to quantitatively measure the eustachian tube (ET) component movements and their interactions captured by transnasal videoendoscopy of the ET during swallowing. DESIGN, SETTING, AND PARTICIPANTS: A blinded analysis of ET mechanics in 33 adults, aged 18 to 54 years, with no middle ear disease at present but without (group 1 [n = 16]) or with (group 2 [n = 17]) history of disease, conducted at a clinical research laboratory. INTERVENTIONS: Videoendoscopy of the ET orifice at the nasopharynx. MAIN OUTCOMES AND MEASURES: Eustachian tube component translations and structural interactions during a swallow and the between-group differences in those variables. After topical anesthesia of the nose, a 45° telescope was introduced unilaterally and focused on the ipsilateral ET orifice. A video recording of ET component movements was made during 3 swallows. Swallow and ET opening durations and times to selected events were calculated. Images at 3 time points were analyzed by measuring the apex angle, the medial-lateral luminal width, and the medial angles between a frame-normal horizontal line through the apex and fixed points on the torus and medial and lateral luminal walls. Linear and angular variables during a swallow were expressed as change from baseline. RESULTS: Luminal opening was driven by soft palate elevation-related medial rotation of the torus and medial wall, coupled with lateral wall fixedness. The magnitude of the change from baseline for most variables was statistically greater than 0. Swallow time, palatal elevation time, time interval between maximum palatal elevation, and maximum eustachian tube opening time were not different between groups 1 and 2. Opening time was longer (mean [SD], 0.49 [0.28] vs 0.67 [0.51] seconds; P = .03) in group 2. Higher magnitude of torus rotation (mean [SD], 36.05° [12.96°] vs 27.72° [9.45°]; P = .002) with maximum soft palate elevation in group 1 resulted in greater degree of eustachian tube orifice widening (mean [SD], 0.34% [0.47%] vs -0.02% [0.49%]; P = .001) compared with the resting position in that group. CONCLUSIONS AND RELEVANCE: This methodology has application in developing quantitative descriptions of ET mechanics in groups of persons without and with history or suspected ET dysfunction. A lesser degree of soft palate elevation during swallow that derives the ET medial lamina rotation and widening of the ET orifice may be associated with poor ET function and higher risk for otitis media. Videoendoscopic evaluation of the ET orifice may assist in diagnosing presence and mechanism of ET dysfunction.

Does contribution of extended vomer flap to palatoplasty affects speech results.

Development of normal speech is the primary goal of successful palatoplasty. The purpose of this study was to determine the importance of the contribution of vomer flap to palatoplasty procedure for speech function. Eighty-one children who underwent 2 flap palatoplasty procedures for cleft palate repair between 2002 and 2010 were retrospectively reviewed in 3 groups. Group 1 underwent palatoplasty without contribution of vomer flap. Group 2 underwent palatoplasty with standard dissection of vomer flap, whereas group 3 underwent palatoplasty with extended dissection of vomer flap. Speech function of the patients was evaluated using objective assessment tools such as nasopharyngoscopy and nasometer. Eighty-one children who underwent 2 flap palatoplasty were included in this study. The mean age at palatoplasty was 10.17 months, and mean length of follow-up was 72.33 months. For most syllables, patients repaired using extended vomer flap demonstrated lower nasalance scores. Nasopharyngoscopic examination revealed velopharyngeal motility in 24 patients (80%) in group 1 and in 20 (83.3%) and 23 (85.2%) patients in groups 2 and 3, respectively (P = 0.930). In velopharyngeal closure, there were only 5 patients (18.5%) in group 3, whereas there were 6 patients (25.0%) for group 2 and 10 patients (33.3%) for group 1 with no closure (P = 0.311). Although most optimum results were observed in the group with extended dissection of the vomer flap, contribution of the extended vomer flap to the repair of the soft palate did not lead to significantly better speech results.

A review of the tensor veli palatine function and its relevance to palatoplasty.

Abstract The main purpose of palatoplasty is to establish normal speech and deglutition. To enhance the chance of successful palatal repair, as well as optimal velopharyngeal competence, the anatomy of the palate has to be thoroughly understood. While carrying out the repair, some surgeons prefer to cut the tensor veli palatini (TVP) tendon, others perform a tenopexy or fracture the hamulus around which the tendon passes, to facilitate mobilisation of palatal tissue. However, the exact anatomy and function of the TVP is still controversial and severing the tendon or its path could be of potential harm. A review of the literature was conducted to summarise the current knowledge of the TVP and its relevance to palatoplasty. It was found that there is sufficient evidence that the TVP plays an important part in velar tautening and Eustachian tube opening, under normal circumstances. TVP's role in the cleft patient population is, however, less certain. Whether or not TVP tenotomy or dislocation reduces ET function further in these patients is also unclear. There is, however, little or no evidence of reduced middle ear effusions if such actions are avoided, at least not in children younger than 3 years of age.

Calibration of a 3D endoscopic system based on active stereo method for shape measurement of biological tissues and specimen.

For endoscopic medical treatment, measuring the size and shape of the lesion, such as a tumor, is important for the improvement of diagnostic accuracy. We are developing a system to measure the shapes and sizes of living tissue by active stereo method using a normal endoscope on which a micro pattern projector is attached. In order to perform 3D reconstruction, estimating the intrinsic and extrinsic parameters of the endoscopic camera and the pattern projector is required. Particularly, calibration of the pattern projector is difficult. In this paper, we propose a simultaneous estimation method of both intrinsic and extrinsic parameters of the pattern projector. This simplifies the calibration procedure required in practical scenes. Furthermore, we have developed an efficient user interface to intuitively operate the calibration and reconstruction procedures. Using the developed system, we measured the shape of an internal tissue of the soft palate of a human and a biological specimen.

Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type.

PURPOSE: The aim of this study was to investigate the relevance of sex, age, and cleft type to velopharyngeal function after primary Sommerlad palatoplasty so as to improve velopharyngeal function after the procedure. PATIENTS AND METHODS: Records of 503 patients with nonsyndromic cleft palate after primary Sommerlad palatoplasty were included in the retrospective study. Relevance between their velopharyngeal function and sex, age, and cleft type was analyzed. Statistical analysis was performed using SPSS 13.0 (SPSS Inc., Chicago, IL). RESULTS: There were no significant differences of velopharyngeal competence (VPC) rates between different sexes (P = 0.635). Specifically, VPC rates were significantly higher in younger-than-2-years groups than in older age groups (P < 0.05) and significantly lower in 6-years-or-older group (P < 0.05). No differences were found among 2- to 6-year-old groups (P > 0.05). The VPC rates were significantly lower in the bilateral complete cleft palate and the unilateral complete cleft palate than in the incomplete cleft palate before 2 years old (P < 0.05), whereas there were no significant differences totally (P = 0.875). Results showed that the disparity of the VPC rate among different cleft types would decrease with age. Moreover, results of multivariate logistic regression also indicated that operation age and cleft type are factors influencing velopharyngeal function. CONCLUSIONS: Primary palatoplasty should be completed before 2 years old, and the postoperative velopharygeal function will greatly decreases after 6 years old. The influence of cleft type on velopharyngeal function is limited to young patients. For those who have missed the best surgical timing, appropriate delay of operation age is reasonable, especially for patients with complete cleft palate. For patients 4 to 6 years old, the first choice is still simple palatoplasty no matter which cleft type they are classified into.

A rat model for muscle regeneration in the soft palate.

BACKGROUND: Children with a cleft in the soft palate have difficulties with speech, swallowing, and sucking. Despite successful surgical repositioning of the muscles, optimal function is often not achieved. Scar formation and defective regeneration may hamper the functional recovery of the muscles after cleft palate repair. Therefore, the aim of this study is to investigate the anatomy and histology of the soft palate in rats, and to establish an in vivo model for muscle regeneration after surgical injury. METHODS: Fourteen adult male Sprague Dawley rats were divided into four groups. Groups 1 (n = 4) and 2 (n = 2) were used to investigate the anatomy and histology of the soft palate, respectively. Group 3 (n = 6) was used for surgical wounding of the soft palate, and group 4 (n = 2) was used as unwounded control group. The wounds (1 mm) were evaluated by (immuno)histochemistry (AZAN staining, Pax7, MyoD, MyoG, MyHC, and ASMA) after 7 days. RESULTS: The present study shows that the anatomy and histology of the soft palate muscles of the rat is largely comparable with that in humans. All wounds showed clinical evidence of healing after 7 days. AZAN staining demonstrated extensive collagen deposition in the wound area, and initial regeneration of muscle fibers and salivary glands. Proliferating and differentiating satellite cells were identified in the wound area by antibody staining. CONCLUSIONS: This model is the first, suitable for studying muscle regeneration in the rat soft palate, and allows the development of novel adjuvant strategies to promote muscle regeneration after cleft palate surgery.