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Sitzman TJ, Williams JL, Singh DJ, Temkit M, Snodgrass TD, Perry JL. Magnetic Resonance Imaging of the Velopharynx: Clinical Findings in Patients with Velopharyngeal Insufficiency. Plast Reconstr Surg 2024; 153:1155e-1168e. [PMID: 38810162 DOI: 10.1097/prs.0000000000010798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles: the primary muscles responsible for velopharyngeal closure during speech. MRI has been used to describe normal anatomy and physiology of the velopharynx in research studies, but there is limited experience with use of MRI in the clinical evaluation of patients with velopharyngeal insufficiency (VPI). METHODS MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, nonsedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared with age- and sex-matched individuals with normal speech resonance. RESULTS MRI was completed successfully in 113 of 118 patients (96%). Compared with controls, patients with VPI after cleft palate repair had a shorter velum (P < 0.001), higher incidence of LVP discontinuity (P < 0.001), and shorter effective velar length (P < 0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane [11 of 15 (73%)], shorter velum (P < 0.001), and higher incidence of LVP discontinuity (P = 0.014). Patients presenting with noncleft VPI had a shorter (P = 0.004) and thinner velum (P < 0.001) and higher incidence of LVP discontinuity (P = 0.014). CONCLUSIONS MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is unavailable with traditional VPI imaging tools, suggesting that MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.
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Affiliation(s)
- Thomas J Sitzman
- Phoenix, Scottsdale, and Tempe AZ; and Greenville, NC
- From the Division of Plastic Surgery
- Department of Clinical Research, Phoenix Children's Hospital
- Barrow Cleft and Craniofacial Center
- Division of Plastic Surgery, Mayo Clinic Arizona
- Department of Speech and Hearing Science, Arizona State University
- Department of Communication Sciences and Disorders, East Carolina University
| | - Jessica L Williams
- Barrow Cleft and Craniofacial Center
- Department of Speech and Hearing Science, Arizona State University
| | - Davinder J Singh
- Phoenix, Scottsdale, and Tempe AZ; and Greenville, NC
- From the Division of Plastic Surgery
- Department of Clinical Research, Phoenix Children's Hospital
- Barrow Cleft and Craniofacial Center
- Division of Plastic Surgery, Mayo Clinic Arizona
- Department of Speech and Hearing Science, Arizona State University
- Department of Communication Sciences and Disorders, East Carolina University
| | - M'hamed Temkit
- Department of Clinical Research, Phoenix Children's Hospital
| | - Taylor D Snodgrass
- Department of Communication Sciences and Disorders, East Carolina University
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University
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Sitzman TJ, Baylis AL, Perry JL, Weidler EM, Temkit M, Ishman SL, Tse RW. Protocol for a Prospective Observational Study of Revision Palatoplasty Versus Pharyngoplasty for Treatment of Velopharyngeal Insufficiency Following Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:870-881. [PMID: 36562144 PMCID: PMC10287832 DOI: 10.1177/10556656221147159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI). DESIGN Prospective observational multicenter study. SETTING Twelve hospitals across the United States and Canada. PARTICIPANTS Individuals who are 3-23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants. INTERVENTIONS Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team. MAIN OUTCOME MEASURE(S) The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. RESULTS Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. CONCLUSIONS Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Adriane L. Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Speech Language Hearing Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders East Carolina University, Greenville, North Carolina, USA
| | - Erica M. Weidler
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - M’hamed Temkit
- Department of Clinical Research, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raymond W. Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
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Perry JL, Snodgrass TD, Gilbert IR, Sutton BP, Baylis AL, Weidler EM, Tse RW, Ishman SL, Sitzman TJ. Establishing a Clinical Protocol for Velopharyngeal MRI and Interpreting Imaging Findings. Cleft Palate Craniofac J 2024; 61:748-758. [PMID: 36448363 PMCID: PMC10243551 DOI: 10.1177/10556656221141188] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Traditional imaging modalities used to assess velopharyngeal insufficiency (VPI) do not allow for direct visualization of underlying velopharyngeal (VP) structures and musculature which could impact surgical planning. This limitation can be overcome via structural magnetic resonance imaging (MRI), the only current imaging tool that provides direct visualization of salient VP structures. MRI has been used extensively in research; however, it has had limited clinical use. Factors that restrict clinical use of VP MRI include limited access to optimized VP MRI protocols and uncertainty regarding how to interpret VP MRI findings. The purpose of this paper is to outline a framework for establishing a novel VP MRI scan protocol and to detail the process of interpreting scans of the velopharynx at rest and during speech tasks. Additionally, this paper includes common scan parameters needed to allow for visualization of velopharynx and techniques for the elicitation of speech during scans.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Taylor D Snodgrass
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Imani R Gilbert
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Bradley P Sutton
- Bioengineering Department, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Erica M Weidler
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Stacey L Ishman
- Division of HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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Mason KN, Hanson B, Black JS. Measurement Matters: MRI Analysis of Differing Anatomic Measurement Techniques for Velar Length and the Velopharyngeal Needs Ratio. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5617. [PMID: 38375369 PMCID: PMC10876255 DOI: 10.1097/gox.0000000000005617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
Background Advances in imaging tools provide opportunities to enhance how velopharyngeal (VP) variables are quantified to facilitate surgical decisions. The purpose of this study was to use magnetic resonance imaging (MRI) to determine if quantitative differences were present between measures of linear and curvilinear velar length, and subsequently, the VP needs ratio. Methods Data were prospectively collected from patients presenting with repaired cleft palate and/or congenital palatal insufficiency with or without VPI at a single center tertiary children's hospital. Quantitative measures of the velopharynx using a novel nonsedated MRI protocol were obtained. Paired samples t tests were conducted to assess if differences were present between the VP needs ratio and measurements of linear and curvilinear velar length at rest and during sustained phonation. Intraclass correlation coefficients were calculated to assess intra/inter-rater reliability. Results Significant differences were present between measurements of linear and curvilinear velar length at rest (P ≤ 0.001) and during sustained phonation (P ≤ 0.001). Significant differences were also present in the VP needs ratio (P ≤ 0.001). Curvilinear velar length at rest and during sustained phonation was longer than that of linear velar length at rest and during sustained phonation. No significant differences were observed between measures of effective velar length (P = 0.393). Conclusions Measurement differences influence the VP needs ratio. This may have implications for comparisons to previously reported normative reference values and for those who are anatomically at risk for VPI. MRI provides an enhanced imaging modality to assess normative benchmarks and the anatomic variables used to define VP anatomy for clinical decision-making.
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Affiliation(s)
- Kazlin N. Mason
- From the Department of Human Services, University of Virginia, Charlottesville, Va
| | - Bailey Hanson
- From the Department of Human Services, University of Virginia, Charlottesville, Va
| | - Jonathan S. Black
- Division of Plastic Surgery, University of Virginia Health System, Charlottesville, Va
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Perry JL, Lee MK, Tahmasebifard N, Gilbert IR, Snodgrass TD, Shaffer JR, Schleif EP, Weinberg SM. Sex Differences in Velopharyngeal Anatomy of 9- and 10-Year-Old Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4828-4837. [PMID: 37902502 PMCID: PMC11008425 DOI: 10.1044/2023_jslhr-23-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Understanding the normal anatomy of velopharyngeal (VP) mechanism and the emergence of sexual dimorphism provides valuable insights into differences of VP anatomy among males and females. The purpose of this study is to examine sex differences in VP anatomy in a large data set of 3,248 9- and 10-year-old children. METHOD Static three-dimensional magnetic resonance imaging was used to compare five VP characteristics including velar length, velar thickness, effective velar length, levator veli palatini muscle length, and pharyngeal depth between age-matched males (n = 1,670) and females (n = 1,578). Additionally, these dimensions were used to determine the VP ratio and effective VP ratio. RESULTS Males showed significantly larger dimensions for all VP distances and significantly lower ratios of velar length and effective velar length to pharyngeal depth (p < .05). The magnitude of these effect sizes was small to medium, with Cohen's d values ranging from 0.12 to 0.63. Additionally, the VP ratio and effective VP ratio are lower among males compared to females (p < .05). CONCLUSIONS Results suggest the presence of sexual dimorphism in the VP mechanism among 9- and 10-year-old children. These findings emphasize the necessity of using different normative data for males and females when making comparisons to patients with cleft palate.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Myoung Keun Lee
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, PA
| | - Neda Tahmasebifard
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Imani R Gilbert
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Taylor D Snodgrass
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - John R Shaffer
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, PA
- Department of Human Genetics, University of Pittsburgh, PA
| | - Eshan Pua Schleif
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Seth M Weinberg
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, PA
- Department of Human Genetics, University of Pittsburgh, PA
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Perry JL, Williams JL, Snodgrass TD, Sitzman TJ. VPI Management in SATB2 Syndrome: Use of MRI to Evaluate Anatomy and Physiology in Non-Cleft VPI. Cleft Palate Craniofac J 2023; 60:1499-1504. [PMID: 35695193 PMCID: PMC10183239 DOI: 10.1177/10556656221106888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This clinical case study describes the velopharyngeal anatomy and physiology in a patient who presented with SATB2-associated syndrome (SAS) and velopharyngeal insufficiency (VPI) in the absence of an overt cleft palate. The clinical presentation, treatment, outcome, and the contribution of anatomical findings from MRI to surgical treatment planning for this rare genetic disorder, SAS, are described. This case study contributes to our current understanding of the anatomy and physiology of the velopharyngeal mechanism in an individual born with SAS and non-cleft VPI. It also details the changes following bilateral buccal myomucosal flaps in this patient.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Jessica L Williams
- Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA
| | - Taylor D Snodgrass
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Thomas J Sitzman
- Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Perry JL, Gilbert IR, Xing F, Jin R, Kuehn DP, Shosted RK, Woo J, Liang ZP, Sutton BP. Preliminary Development of an MRI Atlas for Application to Cleft Care: Findings and Future Recommendations. Cleft Palate Craniofac J 2023:10556656231183385. [PMID: 37335134 DOI: 10.1177/10556656231183385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To introduce a highly innovative imaging method to study the complex velopharyngeal (VP) system and introduce the potential future clinical applications of a VP atlas in cleft care. DESIGN Four healthy adults participated in a 20-min dynamic magnetic resonance imaging scan that included a high-resolution T2-weighted turbo-spin-echo 3D structural scan and five custom dynamic speech imaging scans. Subjects repeated a variety of phrases when in the scanner as real-time audio was captured. SETTING Multisite institution and clinical setting. PARTICIPANTS Four adult subjects with normal anatomy were recruited for this study. MAIN OUTCOME Establishment of 4-D atlas constructed from dynamic VP MRI data. RESULTS Three-dimensional dynamic magnetic resonance imaging was successfully used to obtain high quality dynamic speech scans in an adult population. Scans were able to be re-sliced in various imaging planes. Subject-specific MR data were then reconstructed and time-aligned to create a velopharyngeal atlas representing the averaged physiological movements across the four subjects. CONCLUSIONS The current preliminary study examined the feasibility of developing a VP atlas for potential clinical applications in cleft care. Our results indicate excellent potential for the development and use of a VP atlas for assessing VP physiology during speech.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Imani R Gilbert
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Fangxu Xing
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Riwei Jin
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - David P Kuehn
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Ryan K Shosted
- Department of Linguistics, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Zhi-Pei Liang
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bradley P Sutton
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Mason KN, Black J. Incorporating Velopharyngeal MRI into the Clinical Decision-Making Process for a Patient Presenting with Velopharyngeal Dysfunction Following a Failed Palatoplasty. Cleft Palate Craniofac J 2023:10556656231173500. [PMID: 37143294 PMCID: PMC10624648 DOI: 10.1177/10556656231173500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
This clinical report describes the implementation of magnetic resonance imaging (MRI) to evaluate a patient with long-standing velopharyngeal dysfunction. She was referred to the craniofacial clinic at age 10 with no prior surgical history and subsequently completed a Furlow palatoplasty due to a suspected submucous cleft palate. However, results were unfavorable with minimal improvement in speech or resonance. The clinical presentation, treatment, outcomes, and contributions from MRI for secondary surgical planning are described. Addition of MRI into the clinical workflow provided insights into the anatomy and physiology of the velopharyngeal mechanism that were unable to be obtained from nasendoscopy and speech evaluation alone.
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Affiliation(s)
- Kazlin N. Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, 22903
| | - Jonathan Black
- University of Virginia Health System, Division of Plastic Surgery, Charlottesville, VA, 22903
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Fujiki RB, Kostas G, Thibeault SL. Relationship Between Auditory-Perceptual and Objective Measures of Resonance in Children with Cleft Palate: Effects of Intelligibility and Dysphonia. Cleft Palate Craniofac J 2023:10556656231162238. [PMID: 36890706 DOI: 10.1177/10556656231162238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Relationship between auditory-perceptual ratings of resonance and nasometry scores. Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed. Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.
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Affiliation(s)
| | - George Kostas
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
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Kotlarek KJ, Sitzman TJ, Williams JL, Perry JL. Nonsedated Magnetic Resonance Imaging for Visualization of the Velopharynx in the Pediatric Population. Cleft Palate Craniofac J 2023; 60:249-252. [PMID: 34787476 PMCID: PMC9110557 DOI: 10.1177/10556656211057361] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Non-sedated MRI is gaining traction in clinical settings for visualization of the velopharynx in children with velopharyngeal insufficiency. However, the behavioral adaptation and training aspects that are essential for successful pediatric MRI have received limited attention. SOLUTION We outline a program of behavioral modifications combined with patient education and provider training that has led to high success rates for non-sedated velopharyngeal MRI in children.
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Affiliation(s)
- Katelyn J. Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA, Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA, Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Jessica L. Williams
- Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA, Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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11
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How Early Can We Predict the Need for VPI Surgery? Plast Reconstr Surg Glob Open 2022; 10:e4678. [PMID: 36438464 PMCID: PMC9682615 DOI: 10.1097/gox.0000000000004678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Velopharyngeal dimensions change as a child with cleft palate (CP) grows. The aim of this study was to assess if the decision for velopharyngeal insufficiency (VPI) surgery can be made by the age of 3 years among CP children with moderate-to-severe VPI. In addition, we sought to clarify if speech therapy before VPI surgery is beneficial for VPI speech characteristics. METHODS This retrospective study reviewed documentation of children with moderate-to-severe VPI at age 3 years who did not undergo VPI surgery until age 5 years. Based on the national cleft register, 959 patients with syndromic and nonsyndromic CP were treated by the craniofacial team at Helsinki University Hospital, Finland between 2000 and 2014. Eighty-six patients fulfilled the study inclusion criteria. The speech pathologist evaluated velopharyngeal function at age 3, 5, and 8 years. RESULTS Of the 86 children presenting with moderate-to-severe VPI at age 3 years, 94% still had moderate-to-severe VPI at age 5 years, even though speech therapy was offered to 77%. Of those whose velopharyngeal function improved by age 5 years, function regressed to incompetent over time. Overall, 93% underwent VPI surgery and 82% underwent VPI surgery between ages 5 and 8 years. Only 23% at age 8 years still had moderate-to-severe VPI. Speech therapy alone did not improve VPI speech characteristics. CONCLUSIONS Moderate-to-severe VPI did not improve from 3 to 5 years or improved but subsequently relapsed. This suggests that the decision for VPI surgery can be made for children aged 3 years with moderate-to-severe VPI.
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Power S, Kotlarek KJ. An Exploratory Investigation of the Palatoglossus Muscle in Children Using Magnetic Resonance Imaging. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4151-4158. [PMID: 36283682 PMCID: PMC9940889 DOI: 10.1044/2022_jslhr-22-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE There is currently little evidence reporting the typical morphology of the palatoglossus (PG) muscle. The primary purpose of this exploratory study is to determine whether magnetic resonance imaging (MRI) methods used to quantify the morphology of the levator veli palatini (LVP) muscle can be applied to the PG. The secondary purpose is to provide preliminary data regarding the relationship between the LVP and PG muscles in children. METHOD Ten children between ages of 4 and 7 years participated in this study. Each participant was scanned using a nonsedated, child-friendly protocol with a T2-weighted, three-dimensional anatomical scan to obtain images of the oropharyngeal anatomy. Custom, oblique-coronal image planes were created to visualize and measure the LVP and PG muscles in their entirety from origin to insertion. Thermo Scientific Amira Software was used to obtain 2D measurements of PG muscle length, width, velar insertion distance, lingual insertion distance, and several angle measurements. RESULTS The PG ranged from 17.95 to 26.96 mm in length across participants. Velar insertion distance ranged from 17.22 to 30.95 mm. Lingual insertion distance ranged from 26.91 to 36.02 mm. Width ranged from 2.32 to 3.08 mm. The angle formed by the PG and LVP muscle planes ranged from 7.3° to 52.7°. The LVP insertion angle ranged from 42.5° to 75.9°. The PG insertion angle ranged from 16.9° to 52.3°. CONCLUSIONS MRI was successful in visualizing the PG muscle. The PG was consistent in size and shape within an individual participant but varied across the participant cohort.
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Affiliation(s)
- Samantha Power
- Division of Communication Disorders, University of Wyoming, Laramie
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13
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Kotlarek KJ, Levene S, Piccorelli AV, Barhaghi K, Neuberger I. Growth Effects on Velopharyngeal Anatomy Within the First 2 Years of Life. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3365-3376. [PMID: 36001858 DOI: 10.1044/2022_jslhr-22-00186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
| | - Sierra Levene
- University of Washington School of Medicine, Seattle
| | | | - Krystle Barhaghi
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Ilana Neuberger
- Department of Radiology, University of Colorado School of Medicine, Aurora
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Chuang YJ, Hwang SJ, Buhr KA, Miller CA, Avey GD, Story BH, Vorperian HK. Anatomic development of the upper airway during the first five years of life: A three-dimensional imaging study. PLoS One 2022; 17:e0264981. [PMID: 35275939 PMCID: PMC8916633 DOI: 10.1371/journal.pone.0264981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/21/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Normative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies. Methods The growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion’s superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances. Results Growth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region. Conclusions Our findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions.
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Affiliation(s)
- Ying Ji Chuang
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Seong Jae Hwang
- Department of Computer Science, University of Pittsburgh, Pittsburg, Pennsylvania, United States of America
| | - Kevin A. Buhr
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Courtney A. Miller
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gregory D. Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Brad H. Story
- Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Houri K. Vorperian
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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15
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Perry JL, Haenssler AE, Kotlarek KJ, Fang X, Middleton S, Mason R, Kuehn DP. A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1282-1293. [PMID: 35239427 PMCID: PMC9499359 DOI: 10.1044/2021_jslhr-21-00514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the posterior pharyngeal wall of the nasopharynx. During childhood, the adenoid pad serves as a contact site for the soft palate to assist with velopharyngeal closure during oral speech. During adenoidal involution, most children are able to maintain appropriate velopharyngeal closure necessary for normal speech resonance. The purpose of this study is to determine age-related trends of normal adenoid growth and involution from infancy through adulthood. METHOD/DESCRIPTION Lateral view magnetic resonance imaging was used to analyze velopharyngeal variables among 270 participants, between 3 months and 34 years of age. The velopharyngeal measures of interest included velar length, effective velar length, pharyngeal depth, adenoid height, adenoid thickness, adenoid depth, and adenoid area. Participants were divided into four age groups for statistical comparison. RESULTS There was a statistically significant difference (p < .05) in all linear and area measurements between the four age groups. Adenoid depth reached peak growth at age 4 years, whereas adenoid height and adenoid thickness peaked at 8 years of age. Qualitatively, adenoid growth progresses in an anterior and inferior direction whereas involution occurs in a posterior and superior direction. CONCLUSIONS This study contributes to the knowledge of time specific changes across an age span for adenoid growth and involution and presents a visualization of the shape and growth trends of adenoids. A new sequence of involution is reported beginning first with adenoid depth, followed by adenoid height at a slightly faster rate than adenoid thickness.
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Affiliation(s)
- Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Abigail E. Haenssler
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
- MGH Institute of Health Professions, Boston, MA
| | | | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC
| | - Shea Middleton
- Department of Engineering, East Carolina University, Greenville, NC
| | - Robert Mason
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - David P. Kuehn
- Department of Speech and Hearing Science, University of Illinois Urbana–Champaign
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16
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What is the Fate of the Pedicled Buccal Fat Pad Flap When Used During Primary Palatoplasty? J Craniofac Surg 2022; 33:e173-e175. [PMID: 34560738 PMCID: PMC8943470 DOI: 10.1097/scs.0000000000008238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
ABSTRACT Pedicled buccal fat pad flaps have more recently been applied to primary cleft palate reconstruction, and yet the integrity of the flap and the long-term impact on the palate has not yet been studied. This case study uses magnetic resonance imaging to evaluate the composition of the soft palate 5 years after the interpositional placement of bilateral pedicled buccal fat pad flaps during primary palatoplasty. Anatomical measures are used to quantify the flap and surrounding velopharynx using magnetic resonance imaging and three-dimensional computer technology, indicating that this surgical technique may have a lasting impact for children with cleft palate.
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Mason KN, Riski JE, Williams JK, Jones RA, Perry JL. Utilization of 3D MRI for the Evaluation of Sphincter Pharyngoplasty Insertion Site in Patients With Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2021; 59:1469-1476. [PMID: 34569298 DOI: 10.1177/10556656211044656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgical failure is often noted and postoperative assessment frequently reveals low-set pharyngoplasties. Past studies have not quantified pharyngoplasty tissue changes that occur postoperatively and gaps remain related to the patient-specific variables that influence postoperative change. The purpose of this study was to utilize advanced three-dimensional imaging and volumetric magnetic resonance imaging (MRI) data to visualize and quantify pharyngoplasty insertion site and postsurgical tissue changes over time. A prospective, repeated measures design was used for the assessment of craniometric and velopharyngeal variables postsurgically. Imaging was completed across two postoperative time points. Tissue migration, pharyngoplasty dimensions, and predictors of change were analyzed across imaging time points. Significant differences were present between the initial location of pharyngoplasty tissue and the pharyngoplasty location 2 to 4 months postoperatively. The average postoperative inferior movement of pharyngoplasty tissue was 6.82 mm, although notable variability was present across participants. The pharyngoplasty volume decreased by 30%, on average. Inferior migration of the pharyngoplasty tissue was present in all patients. Gravity, scar contracture, and patient-specific variables likely interact, impacting final postoperative pharyngoplasty location. The use of advanced imaging modalities, such as 3D MRI, allows for the quantification and visualization of tissue change. There is a need for continued identification of patient-specific factors that may impact the amount of inferior tissue migration and scar contracture postoperatively.
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Affiliation(s)
- Kazlin N Mason
- Human Services Department, School of Education, 2358University of Virginia, Charlottesville, VA, USA
| | - John E Riski
- Speech Pathology Lab, Center for Craniofacial Disorders, 160364Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joseph K Williams
- Speech Pathology Lab, Center for Craniofacial Disorders, 160364Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Richard A Jones
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jamie L Perry
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, NC, USA
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18
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Alfwaress F, Kummer AW, Weinrich B. Nasalance Scores for Normal Speakers of American English Obtained by the Nasometer II Using the MacKay-Kummer SNAP-R Test. Cleft Palate Craniofac J 2021; 59:765-773. [PMID: 34184583 DOI: 10.1177/10556656211025406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ann W Kummer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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19
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Perry JL, Haenssler AE, Kotlarek KJ, Chen JY, Fang X, Guo Y, Mason K, Webb M. Does the Type of MRI Sequence Influence Perceived Quality and Measurement Consistency in Investigations of the Anatomy of the Velopharynx? Cleft Palate Craniofac J 2021; 59:741-750. [PMID: 34155920 DOI: 10.1177/10556656211025191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Abigail E Haenssler
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Katelyn J Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Joshua Y Chen
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Yifan Guo
- Division of Plastic Surgery, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Kazlin Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
| | - Michael Webb
- Department of Pediatric Dentistry and Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, East Carolina University, Greenville, NC, USA
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20
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Kotlarek KJ, Jaskolka MS, Fang X, Ellis C, Blemker SS, Horswell B, Kloostra P, Perry JL. A Preliminary Study of Anatomical Changes Following the Use of a Pedicled Buccal Fat Pad Flap During Primary Palatoplasty. Cleft Palate Craniofac J 2021; 59:614-621. [PMID: 33973484 DOI: 10.1177/10556656211014070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the surgical impact of the pedicled buccal fat pad (BFP) flap on the levator veli palatini (LVP) muscle and surrounding velopharyngeal (VP) anatomy following primary palatoplasty using magnetic resonance imaging (MRI). DESIGN Observational, prospective. SETTING MRI studies were completed at 3 different facilities. All participants with BFP flap were operated on by the same surgeon. PARTICIPANTS Five pediatric participants with cleft palate with or without cleft lip (CP±L) who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls. INTERVENTIONS All participants underwent nonsedated MRI 2 to 5 years postoperatively. MAIN OUTCOMES AND MEASURES Anatomical measures of the velopharynx and LVP among the 3 participant groups. RESULTS Median values were significantly different among groups for velar length (P = .042), effective velar length (P = .048), effective VP ratio (P = .046), LVP length (P = .021), extravelar LVP length (P = .009), and LVP origin-origin distance (P = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio (P = .040), extravelar LVP length (P = .033), and LVP length (P = .022). CONCLUSIONS This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine whether this procedure provides a more favorable mechanism for VP closure.
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Affiliation(s)
- Katelyn J Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | | | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Charles Ellis
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | | | | | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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21
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Haenssler AE, Fang X, Perry JL. Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3586-3593. [PMID: 32976083 PMCID: PMC8582755 DOI: 10.1044/2020_jslhr-20-00305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games-Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference (p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences (p < .05) for velar length, VP ratio, effective velar length, adenoid depth, and pharyngeal depth. No statistically significant differences between adjacent age groups were reported for the EVP ratio. Conclusions Results from this study report the EVP ratio was not statistically significant between adjacent age groups, whereas the VP ratio was statistically significant between adjacent age groups. This study suggests that the EVP ratio is more correlated to VP function than the VP ratio and provides a more stable and consistent ratio of VP function across the age span.
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Affiliation(s)
- Abigail E. Haenssler
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
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Schenck GC, Perry JL, O'Gara MM, Linde AM, Grasseschi MF, Wood RJ, Lacey MS, Fang X. Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study. Cleft Palate Craniofac J 2020; 58:313-323. [PMID: 32909827 DOI: 10.1177/1055665620954749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Graham C Schenck
- Department of Rehabilitation Therapies, 20731Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-River Falls, River Falls, WI, USA
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| | - Mary M O'Gara
- Department of Pediatric Plastic Surgery, 24183Shriners Hospital for Children-Chicago, Chicago, IL, USA.,Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Morgan Linde
- 174539Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.,Department of Speech, Language, and Hearing Sciences, 174539Western Michigan University, Kalamazoo, MI, USA
| | - Mitchell F Grasseschi
- Department of Pediatric Plastic Surgery, 24183Shriners Hospital for Children-Chicago, Chicago, IL, USA.,Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert J Wood
- Department of Plastic and Craniofacial Surgery, 3605Banner Health System, Phoenix, AZ, USA
| | - Martin S Lacey
- Department of Plastic Surgery, 20731Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Xiangming Fang
- Department of Biostatistics, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
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Kollara L, Baylis AL, Kirschner RE, Bates DG, Smith M, Fang X, Perry JL. Interaction of the craniofacial complex and velopharyngeal musculature on speech resonance in children with 22q11.2 deletion syndrome: An MRI analysis. J Plast Reconstr Aesthet Surg 2020; 74:174-182. [PMID: 32855100 DOI: 10.1016/j.bjps.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/21/2020] [Accepted: 08/01/2020] [Indexed: 01/29/2023]
Abstract
There are limited MRI studies of craniofacial and velopharyngeal features in children with 22q11.2 deletion syndrome (22q11.2DS) and to date, none have explored the potential relationship between these features and the speech phenotype. The purpose of this study was to examine the relationship between craniofacial and related velopharyngeal structures in children with 22q11.2DS and to assess their correlation to resonance features using an unsedated MRI protocol. Fifteen children with 22q11.2DS and 15 age- and sex-matched controls with normal velopharyngeal anatomy (ages 4-12 years) successfully completed the study. Analysis of covariance was used to compare differences between the experimental (22q11.2DS) and control (children with normal anatomy) groups. Correlation analyses and regression models were also utilized. The 22q11.2DS group demonstrated significantly shorter nasion-to-sella, sella-to-basion, and basion-to-opisthion distances. The anterior cranial base angle was significantly more obtuse. The levator veli palatini (levator) muscle was significantly thinner and shorter, with an obtuse angle of origin in the 22q11.2DS group. Levator length was significantly correlated with the sella-to-basion measure and hypernasality was correlated with levator origin-to-origin distance. Preliminary results from this study indicate a significant association between hypernasality and levator origin-to-origin distance. Findings from the present study, provide an insight into the pathophysiology of velopharyngeal dysfunction related to this clinically complex population.
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Affiliation(s)
- Lakshmi Kollara
- School of Communication Sciences and Disorders, University of Central Florida, 4364 Scorpius Street, HPA 2 Suite 101-L, Orlando, FL 32816, United States.
| | - Adriane L Baylis
- Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, United States
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, United States
| | - D Gregory Bates
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, United States
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, United States
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, United States
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, United States
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24
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Perry JL, Kotlarek KJ, Spoloric K, Baylis A, Kollara L, Grischkan JM, Kirschner R, Bates DG, Smith M, Findlen U. Differences in the Tensor Veli Palatini Muscle and Hearing Status in Children With and Without 22q11.2 Deletion Syndrome. Cleft Palate Craniofac J 2019; 57:302-309. [PMID: 31446782 DOI: 10.1177/1055665619869142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the dimensions of the tensor veli palatini (TVP) muscle using high image resolution 3-dimensional magnetic resonance imaging (MRI) of the soft palate among children with normal velopharyngeal and craniofacial anatomy and to compare values to individuals with a diagnosis of 22q11.2 deletion syndrome (22q11DS). We also sought to determine whether there is a relationship between hypoplasia of the TVP and severity of middle ear dysfunction and hearing loss. METHODS Three-dimensional MRI were used to collect and analyze data obtained across 53 children between 4 and 12 years of age, including 40 children with normal velopharyngeal and craniofacial anatomy and 13 children with a diagnosis of 22q11.2 DS. Tensor veli palatini muscle length, thickness, and volume as well as bihamular distance were compared among participant groups. RESULTS A Welch's t-test revealed that the TVP in participants with 22q11DS is significantly shorter (P = .005, 17.3 vs 19.0 mm), thinner (P < .001, 1.1 vs 1.8 mm), and less voluminous (P < .001, 457.5 vs 667.3 mm3) than participants without 22q11DS. Participants with 22q11DS also had a greater (P = .006, 27.7 vs 24.7 mm) bihamular distance than participants without 22q11DS. There was an inverse relationship between TVP abnormalities noted above and the severity of audiologic and otologic histories. CONCLUSION The TVP muscle is substantially reduced in volume, length, and thickness in children with 22q11DS. These findings serve as preliminary support for the association of patient hearing and otologic severity and TVP dysmorphology.
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Affiliation(s)
- Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Katelyn J Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Kelly Spoloric
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Adriane Baylis
- Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Clinical Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lakshmi Kollara
- Department of Clinical Health Sciences, Texas A&M University, Kingsville, TX, USA
| | - Jonathan M Grischkan
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.,Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard Kirschner
- Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Surgery at The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Gregory Bates
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA.,Radiology at The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Smith
- Radiology at The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ursula Findlen
- Division of Clinical Therapies, Audiology Department, Nationwide Children's Hospital, Columbus, OH, USA.,Clinical, Department of Otolaryngology, Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Kotlarek KJ, Haenssler AE, Hildebrand KE, Perry JL. Morphological variation of the velum in children and adults using magnetic resonance imaging. Imaging Sci Dent 2019; 49:153-158. [PMID: 31281792 PMCID: PMC6597378 DOI: 10.5624/isd.2019.49.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/14/2019] [Accepted: 04/10/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate variations in velar shape according to age, sex, and race using magnetic resonance imaging (MRI). MATERIALS AND METHODS The study sample consisted of 170 participants (85 children, 85 adults) between 4 and 34 years of age. Velar morphology was visually classified using midsagittal MRI scans for each participant by 2 independent raters. Inter- and intra-rater reliability was assessed. Statistical analyses were performed to identify correlations of velar shape with sex, age, and race. RESULTS The most frequent velar shape was "butt" for both adults (41%) and children (58%) in this study. The least common shapes for adults were "leaf" and "S." The children did not exhibit any "leaf" or "straight" velar shapes. A statistically significant difference was noted for age with respect to velar shape (P=0.014). Sex and race were found to have no significant impact on velar shape in this study. CONCLUSION When using MRI to evaluate velar morphology, the "butt" shape was most common in both children and adults. Velar shape varied significantly with age, while race and sex did not have a significant impact.
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Affiliation(s)
- Katelyn J. Kotlarek
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Abigail E. Haenssler
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Kori E. Hildebrand
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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Kollara L, Baylis AL, Kirschner RE, Bates DG, Smith M, Fang X, Perry JL. Velopharyngeal Structural and Muscle Variations in Children With 22q11.2 Deletion Syndrome: An Unsedated MRI Study. Cleft Palate Craniofac J 2019; 56:1139-1148. [DOI: 10.1177/1055665619851660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The 22q11.2 deletion syndrome (22q11.2DS) is the most common genetic cause of velopharyngeal dysfunction; however, limited information exists regarding variations in velopharyngeal anatomy in this clinically challenging population. The purpose of this study was to examine velopharyngeal characteristics among young children with 22q11.2DS in comparison to a normative cohort using an innovative, nonsedated magnetic resonance imaging (MRI) scanning protocol. Methods: Fifteen children with 22q11.2DS and 15 age- and gender-matched controls with normal velopharyngeal anatomy (ages 4-12) successfully completed the MRI protocol. Eighteen velopharyngeal and 2 related craniofacial measures were examined. Analysis of covariance was used to compare differences between the experimental and the control groups. Results: The 22q11.2DS group demonstrated a significantly thinner velum ( P < .0005) and a larger pharyngeal depth ( P = .007) compared to the matched control group. Findings in the current study also demonstrated that the levator veli palatini muscle is significantly shorter ( P = .037) and thinner ( P = .025) in the 22q11.2DS cohort, with a significantly shorter origin-to-origin distance ( P < .0005) and a greater angle of origin ( P = .001) compared to healthy peers. Conclusion: Children with 22q11.2DS demonstrated multiple variations that may contribute to velopharyngeal dysfunction by altering the anatomic characteristics of the velopharyngeal port, the levator muscle, and associated structures. This investigation represents the first and largest attempt to characterize velopharyngeal anatomy in children with 22q11.2DS using a nonsedated MRI protocol.
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Affiliation(s)
- Lakshmi Kollara
- Department of Clinical Health Sciences, Texas A&M University-Kingsville, Kingsville, TX, USA
| | - Adriane L. Baylis
- Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, OH, USA
| | - Richard E. Kirschner
- Plastic and Reconstructive Surgery, Nationwide Children’s Hospital,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, OH, USA
| | - D. Gregory Bates
- Department of Radiology, Nationwide Children’s Hospital,The Ohio State University College of Medicine, OH, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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Ruthven M, Freitas AC, Boubertakh R, Miquel ME. Application of radial GRAPPA techniques to single- and multislice dynamic speech MRI using a 16-channel neurovascular coil. Magn Reson Med 2019; 82:948-958. [PMID: 31016802 DOI: 10.1002/mrm.27779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate: (1) the feasibility of using through-time radial GeneRalized Autocalibrating Partially Parallel Acquisitions (rGRAPPA) and hybrid radial GRAPPA (h-rGRAPPA) in single- and multislice dynamic speech MRI; (2) whether single-slice dynamic speech MRI at a rate of 15 frames per second (fps) or higher and with adequate image quality can be achieved using these radial GRAPPA techniques. METHODS Seven healthy adult volunteers were imaged at 3T using a 16-channel neurovascular coil and 2 spoiled gradient echo sequences (radial trajectory, field of view = 192 × 192 mm2 , acquired pixel size = 2.4 × 2.4 mm2 ). One sequence imaged a single slice at 16.8 fps, the other imaged 2 interleaved slices at 7.8 fps per slice. Image sets were reconstructed using rGRAPPA and h-rGRAPPA, and their image quality was compared using the root mean square error, structural similarity index, and visual assessments. RESULTS Image quality deteriorated when fewer than 170 calibration frames were used in the rGRAPPA reconstruction. rGRAPPA image sets demonstrated: (1) in 97% of cases, a similar image quality to h-rGRAPPA image sets reconstructed using a k-space segment size of 4, (2) in 98% of cases, a better image quality than h-rGRAPPA image sets reconstructed using a k-space segment size of 32. CONCLUSION This study confirmed: (1) the feasibility of using rGRAPPA and h-rGRAPPA in single- and multislice dynamic speech MRI, (2) that single-slice speech imaging at a frame rate higher than 15 fps and with adequate image quality can be achieved using these radial GRAPPA techniques.
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Affiliation(s)
- Matthieu Ruthven
- Clinical Physics, Barts Health NHS Trust, St Bartholomew's Hospital, London, United Kingdom
| | - Andreia C Freitas
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom.,ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico - Universidade de Lisboa, Lisbon, Portugal
| | - Redha Boubertakh
- Clinical Physics, Barts Health NHS Trust, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Marc E Miquel
- Clinical Physics, Barts Health NHS Trust, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom
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Perry JL, Kollara L, Sutton BP, Kuehn DP, Fang X. Growth Effects on Velopharyngeal Anatomy From Childhood to Adulthood. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:682-692. [PMID: 30950740 PMCID: PMC6802896 DOI: 10.1044/2018_jslhr-s-18-0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/06/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
Purpose The observed sexual dimorphism of velopharyngeal structures among adult populations has not been observed in the young child (4- to 9-year-old) population. The purpose of this study was to examine the age at which sexual dimorphism of velopharyngeal structures become apparent and to examine how growth trends vary between boys and girls. Method Static 3-dimensional magnetic resonance imaging velopharyngeal data were collected among 202 participants ranging from 4 to 21 years of age. Participants were divided into 3 groups based on age, including Group 1: 4-10 years of age, Group 2: 11-17 years of age, and Group 3: 18-21 years of age. Nine velopharyngeal measures were obtained and compared between groups. Results Significant sex effects were evident for levator length ( p = .011), origin to origin ( p = .018), and velopharyngeal ratio ( p = .036) for those in Group 2 (11-17 years of age). Sex effects became increasingly apparent with age, with 7 of 9 variables becoming significantly different between male and female participants in Group 3. Boys, in general, displayed a delayed growth peak in velopharyngeal growth compared to girls. Conclusion Results from this study demonstrate the growth of velopharyngeal anatomy with sexual dimorphism becoming apparent predominantly after 18 years of age. However, velopharyngeal variables displayed variable growth trends with some variables presenting sexual dimorphism at an earlier age compared to other velopharyngeal variables.
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Affiliation(s)
- Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Lakshmi Kollara
- Department of Clinical Health Sciences, Texas A&M University–Kingsville
| | - Bradley P. Sutton
- Department of Bioengineering, University of Illinois at Urbana-Champaign
| | - David P. Kuehn
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC
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Schenck GC, Perry JL, Kollara L, Kuehn DP. Effects of Surgical Intervention and Continuous Positive Airway Pressure Therapy on Velopharyngeal Structure and Function: A Case Report. Cleft Palate Craniofac J 2018; 56:525-533. [PMID: 30048600 DOI: 10.1177/1055665618787688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Changes to the velum and velopharyngeal muscles following Furlow double-opposing Z-plasty in a 7-year-old female with submucous cleft palate and velopharyngeal dysfunction (VPD) were evaluated. Perceptual, instrumental (ie, nasometry and aerodynamic pressure flow), and research magnetic resonance imaging analyses were used during pre- and postsurgical time points at a university research clinic. Continuous positive airway pressure (CPAP) therapy was trialed following a failed surgery for residual VPD in the patient. Increases in velar length and thickness and decreases in levator veli palatini muscle angle of origin and contraction were observed following the Furlow double-opposing Z-plasty surgery. Variable improvements in residual hypernasality following the home-based CPAP therapy protocol were observed.
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Affiliation(s)
- Graham C Schenck
- 1 Department of Rehabilitation Therapies, Gillette Children's Specialty Healthcare, St Paul, MN, USA.,2 Department of Communication Sciences and Disorders, University of Wisconsin-River Falls, River Falls, WI, USA
| | - Jamie L Perry
- 3 Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Lakshmi Kollara
- 4 Department of Communication Sciences and Disorders, Texas A&M University-Kingsville, Kingsville, TX, USA
| | - David P Kuehn
- 5 Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Evaluating the Accuracy of Using at Rest Images to Determine the Height of Velopharyngeal Closure. J Craniofac Surg 2018; 29:1354-1357. [PMID: 29905582 DOI: 10.1097/scs.0000000000004444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to evaluate the point of attempted velopharyngeal contact along the posterior pharyngeal wall relative to the palatal plane and the first cervical vertebra. The ability to quantify the height of velopharyngeal closure is an important aspect of planning corrective surgeries for velopharyngeal dysfunction. However, issues with patient compliance during the imaging process can present difficulties for obtaining adequate preoperative imaging data. The purpose of this study was to assess if the height of velopharyngeal closure can be accurately estimated and quantified from at rest images. Results demonstrate that the height of velopharyngeal closure above C1 can be accurately quantified using at rest images in children with cleft palate. No statistically significant difference was found between the measures obtained at rest or during sustained phonation images (P = 0.573). Thus, quantitative measures from at rest images can aid in the preoperative planning process by providing surgeons with a numeric distance for tissue insertion along the posterior pharyngeal wall above C1. This distance is correlated to the height of velopharyngeal closure and successfully placing tissue at this height is likely tied to improved postoperative speech outcomes.
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