Identifying Predictors of Levator Veli Palatini Muscle Contraction During Speech Using Dynamic Magnetic Resonance Imaging.

Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women (M = 22.8 years, SD = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of "ansa." Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors (p < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin distance, velar thickness, pharyngeal depth, and velopharyngeal ratio. Significant predictors (p < .05) of maximum contraction velocity during velopharyngeal closure included mean extravelar length, intravelar length, LVP origin-to-origin distance, and velar thickness. Conclusions This study identified six velopharyngeal variables that predict LVP muscle function during real-time speech. These predictors should be considered among children and individuals with repaired cleft palate in future studies.

Asymmetry and Positioning of the Levator Veli Palatini Muscle in Children With Repaired Cleft Palate.

Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle (p = .031) and effective velopharyngeal ratio (p = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length (p = .018), thickness at midline (p = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum (p = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.

A Dynamic Magnetic Resonance Imaging-Based Method to Examine In Vivo Levator Veli Palatini Muscle Function During Speech.

Purpose The aim of this study was to develop a method able to quantify levator veli palatini (LVP) muscle shortening and contraction velocities using dynamic magnetic resonance imaging (MRI) throughout speech samples and relate these measurements to velopharyngeal portal dimensions. Method Six healthy adults (3 men and 3 women, M = 24.5 years) produced syllables representing 4 different manners of production during real-time dynamic MRI scans. We acquired an oblique-coronal slice of the velopharyngeal mechanism, which captured the length of the LVP, and manually segmented each frame. LVP shortening and muscle velocities were calculated from the acquired images. Results Using our method, we found that subjects demonstrated greater LVP shortening and higher maximum contraction velocities during fricative and plosive syllable production than during nasal or vowel syllable production. LVP shortening and maximum contraction velocity positively correlated with velopharyngeal port depth. Conclusions In vivo LVP function differs between manners of production, as expected, and an individual's velopharyngeal portal dimensions influence LVP function. These measures, contextualized with the force-length and force-velocity muscle relationships, provide new insight into LVP function. Future studies could use this method to investigate LVP function in healthy speakers and individuals with velopharyngeal dysfunction and how function relates to velopharyngeal anatomy.

Assessment of velopharyngeal function with dual-planar high-resolution real-time spiral dynamic MRI.

PURPOSE: To develop a real-time dynamic MRI method for comprehensive evaluation of velum movement during speech. METHODS: Dynamic MRI has been used to study velopharyngeal insufficiency (VPI) by imaging the movement of the velum during speech, because it can provide good anatomic details with no exposed radiation. To be able to comprehensively evaluate dynamic velum movement, a real-time spiral non-balanced SSFP sequence was developed with simultaneous dual-planar coverage and improved spatial and temporal resolution using a combination of parallel imaging and spatial and temporal compressed sensing to achieve 6 × acceleration. New off-resonance correction and post-processing methods were also developed to reduce blurring and slice crosstalk. RESULTS: The method demonstrated good image quality for visualizing dynamic velum movement with reduced blurring and improved image homogeneity. Spatial resolution of 1.2*1.2 mm2 with 150 mm FOV and temporal resolution of 20 frames-per-second with simultaneous dual-planar coverage was achieved. CONCLUSIONS: This work describes a new technique for studying speech disorders using dual-planar accelerated spiral dynamic MRI.

A computational model of velopharyngeal closure for simulating cleft palate repair.

The levator veli palatini (LVP) muscle has long been recognized as the muscle that contributes most to velopharyngeal (VP) closure and is therefore of principal importance for restoring normal speech in patients with a cleft palate. Different surgical reconstructive procedures can utilize varying degrees of LVP overlap, and this study developed a new finite-element model of VP closure designed to understand the biomechanical effects of LVP overlap. A three-dimensional finite-element model was created from adult anatomical dimensions and parameters taken from the literature. Velopharyngeal function was simulated and compared with experimental measurements of VP closure force from a previous study. Varying degrees of overlap and separation of the LVP were simulated, and the corresponding closure force was calculated. The computational model compares favorably with the experimental measurements of closure force from the literature. Furthermore, the model predicts that there is an optimal level of overlap that maximizes the potential for the LVP to generate closure force. The model predicts that achieving optimal overlap can increase closure force up to roughly 100% when compared with too little or too much overlap. The results of using this new model of VP closure suggest that optimizing LVP overlap may produce improved surgical outcomes due to the intrinsic properties of muscle. Future work will compare these model predictions with clinical observations and provide further insights into optimal cleft palate repair and other craniofacial surgeries.