Soft Palate Length Research Articles

Cephalometric findings among children with velopharyngeal dysfunction following adenoidectomy-A retrospective study.

To characterise the craniofacial structure by cephalometry, especially the skull base and nasopharyngeal space, in children who underwent adenoidectomy and developed persistent velopharyngeal dysfunction (VPD). Retrospective study. Speech and swallowing clinic of a single academic hospital. Thirty-nine children with persistent VPD following adenoidectomy (mean age 8.0±3.6 years) and a control group of 80 healthy children. Cephalometric landmarks were chosen; craniofacial linear and angular dimensions were measured and analysed. The linear dimensions of the nasopharyngeal area were shorter in the VPD group, S-Ba (41.6±4.2 mm, P<.05) and S-Ptm (42.4±5.1 mm, P<.05). The anterior skull base, N-S, was similar (68.1 mm±6.8). The velum length, Ptm-P was significantly shorter in the VPD group (27.8±4.3 mm, P<.001). The Ba-S-Ptm angle was significantly larger in the VPD group (63.5±5.6°, P<.001). There was no significant difference in cranial base angle (CBA), Ba-S-N, between the two groups. Cephalometry may provide information regarding persistent postoperative VPD. The nasopharyngeal space angle and velar length appear to be risk factors for persistent VPD after adenoidectomy.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Single Z-Plasty Versus Double-Opposing Z-Plasty: A Cadaveric Study of Palatal Lengthening.

The double-opposing Z-plasty is an effective method of repairing the cleft palate due to its reorientation of the palatal musculature and lengthening of the soft palate. A technique for lengthening the palate with a single oral Z-plasty has also been described. The authors hypothesize that these 2 techniques have equivalent effects on palate length. A cadaver study was performed. Ten fresh adult cadaver heads were used.All palates were divided in the midline. In 5 specimens, a modified double-opposing Z-plasty technique was used; 5 other specimens underwent an oral Z-plasty with a straight-line repair of the nasal mucosa. In both groups, the levator veli palatini muscles were separately dissected and reapproximated with an intravelar veloplasty. The velar length, defined in this study as the distance from the posterior nasal spine to the tip of uvula, was measured before and after the surgical procedure. The double-opposing Z-plasty produced a mean increase of 1.0 ± 0.6 cm in velar length (P = 0.023). The single Z-plasty repair resulted in a mean gain of 1.1 ± 0.3 cm (P = 0.001). There was no difference in change in palate length between the 2 procedures (P = 0.941), and no difference in the percentage of soft palate lengthening (24% vs 29%, respectively; P = 0.565). A single oral Z -plasty provides palatal lengthening equivalent to that of a double-opposing Z-plasty procedure.

Modified unilateral buccinator myomucosal flap technique for correction of velopharyngeal Insufficiency due to insufficient palatal length and mobility

Objective To assess the outcome of palate lengthening by modified unilateral myomucosal buccinator flap for velopharyngeal insufficiency (VPI) in terms of speech intelligibility and soft palate length. Methods The study setting was the multi-disciplinary regional cleft center of southern Sri Lanka based at Teaching Hospital, Karapitiya, Galle. A consecutive sample of 60 patients who underwent the modified unilateral buccinator myomucosal flap procedure between 2004 and 2010 were reviewed retrospectively. All patients were assessed six months after the surgery. Palatal length was recorded by direct measurement in millimeters pre and post operatively. Speech was evaluated blindly by a speech therapist using pre and post operative digital speech records. Results Mean increase of palate length after insertion of the buccinator flap was 7.61 ± 1.85 mm with a range of 4 mm to 13 mm. Marked and statistically significant (p Conclusion This paper demonstrates that with the proposed modifications to the unilateral myomucosal buccinator flap, we can achieve satisfactory results in par with or superior to the bilateral myomucosal buccinator flap technique in patients with VPI due to short palate length and/or decrease mobility of soft palate.

Examining Velopharyngeal Closure Patterns Based on Anatomic Variables.

The purpose of this study was to use three-dimensional magnetic resonance imaging to correlate velopharyngeal closure patterns with velopharyngeal anatomic structural characteristics. Thirty-eight participants (18 females and 20 males) between 19 and 32 years of age participated in the study. Participants were evaluated using magnetic resonance imaging and nasopharyngoscopy to determine closure pattern type and their relationship to anatomic characteristics believed to influence velopharyngeal closure. Structural anatomic measures were completed in the vertical (nasopharyngeal length) and horizontal (nasopharyngeal width) planes. Anterior to posterior dimensions of pharyngeal depth, posterior pharyngeal wall thickness, velar length, effective velar length, and adenoid thickness were also completed. Velar length and adenoid thickness varied based on closure patterns, with coronal closure pattern demonstrating significantly larger values than circular closure pattern. There were no statistically significant differences for effective velar length, pharyngeal depth, nasopharyngeal length, posterior pharyngeal wall thickness, and nasopharyngeal width based on the type of closure pattern. Closure patterns varied by sex, with females demonstrating more circular closure patterns than males who demonstrated more coronal closure patterns. Nasopharyngeal length, velar length, and nasopharyngeal width also varied by sex, with males demonstrating significantly larger values than females. Statistically significant differences were observed in velopharyngeal anatomic structural measures and sex during evaluations of closure patterns. These preliminary findings indicate that the length of the velum and thickness of the adenoids may have the greatest impact on velopharyngeal closure patterns.

CT with 3D reconstruction of upper respiratory tract in obstructive sleep apnea hypopnea syndrome application

Objective To investigate the relationship between the obstructive sleep apnea hypopnea syndrome (OSAHS) patient's structure of the upper airway and severity of OSAHS. Methods A total of 77 cases (22 cases of mild, moderate 22 cases, 33 cases of severe) of OSAHS patients and normal controls were 22 cases, in the three-dimensional structure of the downstream CT airway remodeling, measuring soft palate length, thickness, soft palate roots, uvula, tongue, epiglottis away from the posterior pharyngeal wall distance relationship with the severity of OSAHS. Results ⑴ In patients with OSAHS, the soft palate length [mild group (41.77±9.14) mm, moderate group (40.30±7.74) mm and severe group (40.64±9.64)mm] and normal control group [(40.25±7.55)mm] compared, the difference was not statistically significant (P>0.05); the thickness of soft palate [mild group (10.00±3.40)mm, moderate group (10.31±2.53)mm] and normal control group [(9.88±2.02)mm] compared, the difference was not statistically significant (P>0.05), severe group [(11.49±2.62)mm] and normal control group compared, the difference was statistically significant (P<0.05). ⑵ In calm inspiratory breath hold and severe OSAHS patients epiglottis from posterior pharyngeal wall distance was longer than the moderate OSAHS group [(10.75±5.18)mm vs (7.61±3.57)mm], the difference was statistically significant (P<0.05); after deep inspiratory breath hold, OSAHS patients in the severe group uvula from posterior pharyngeal wall distance was shorter than in normal control group [(4.82±3.33)mm vs (7.10±4.64)mm], the difference was statistically significant (P<0.05). ⑶ In patients with OSAHS thickness of soft palate with body mass index (BMI) and apnea hypopnea index (AHI) were positively correlated (r=0.333, P<0.01; r=0.226, P<0.05), and with lowest pulse oxygen saturation (LSpO2) and mean pulse oxygen saturation (MSpO2) were negative correlation (r=-0.283, P<0.05; r=-0.400, P<0.01); in calm breathing and forced inspiratory breath hold, the soft palate roots from the posterior pharyngeal wall distance and BMI were negatively related (r=-0.297, P<0.01; r=-0.232, P<0.05); in calm inspiratory breath hold root of the tongue from the posterior pharyngeal wall distance and MSpO2 was negatively related (r=-0.225, P<0.05); in calm inspiratory breath hold epiglottis from the posterior pharyngeal wall distance and AHI was positively correlated (r=0.277, P<0.05), and negatively related (r=-0.289, P<0.05) with MSpO2; in forced inspiratory breath hold uvula from retropharyngeal wall distance and MSpO2 was positively correlated (r=0.260, P<0.05). Conclusions OSAHS patients through upper airway CT reconstruction with polysomnography (PSG) indicators combine to determine the severity of OSAHS disease pathogenesis studies, can be used as indicators to determine the therapeutic effect, have clinical significance. Key words: Tomography, X-ray computed; Sleep apnea, obstructive/RA

Relationship Between Age and Diagnosis on Volumetric and Linear Velopharyngeal Measures in the Cleft and Noncleft Populations.

The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imaging (MRI) of the nasopharyngeal space and adenoid tissue and to examine the relationship between nasopharyngeal volume (NPV), adenoid volume, and linear measures of the velopharyngeal structures, pharynx, and vocal tract in children with and without cleft palate. A total of 24 participants including 18 typically developing children (4-8 years of age) and 6 children (4-8 years of age) with varying degrees of cleft palate were imaged using MRI. Linear and volumetric variables varied significantly based on age. Overall, NPV demonstrates a modest increase with age. Nasopharyngeal volume was positively correlated with age (P = 0.000), oronasopharyngeal volume (P = 0.000), velar length (P = 0.018), and velar thickness (P = 0.046). These variables tend to increase together. Differences in NPV between groups (bilateral cleft lip and palate, submucous cleft lip and palate, unilateral cleft lip and palate [UCLP], and noncleft) were statistically significant (P = 0.007). Participants with bilateral cleft lip and palate demonstrated greater NPVs than those with UCLP and submucous cleft palate.

Perceptual-Speech, Nasometric, and Cephalometric Results After Modified V-Y Palatoplasties With or Without Mucosal Graft.

Although the goal of cleft palate (CP) repair is to achieve normal speech, no standard procedure ensures that patients' speech will be at the same level as speech in children without CP. In this study, postoperative speech outcomes following primary CP repair combined with or without a mucosal graft was analyzed in comparison with that of control subjects without CP. Eighty-two patients who underwent modified V-Y palatoplasty with a mucosal graft on the nasal side for symmetrical muscular reconstruction during 2006-2012 (MG group) and 109 patients who previously underwent modified V-Y palatoplasty without a mucosal graft (non-MG group) were enrolled in this study. Speech data on 37 Japanese subjects without CP were used as a control. Perceptual rating of resonance and nasal emission and nasometry were carried out for all participants. Furthermore, cephalometric analyses were performed to assess postoperative velopharyngeal morphology and velar movement. Normal resonance was achieved at a significantly higher rate (90.3% of patients) in the MG group than in the non-MG group (68.8%) (P < .01). The mean nasalance scores in the MG group were significantly lower (P < .01) and were almost at the same level as in controls. Cephalometric analyses revealed a greater velar length and velar elevation angle during phonation in the MG group (P < .01 and P < .05, respectively). Modified V-Y palatoplasty combined with a mucosal graft on the nasal side of the velum for symmetrical muscular reconstruction facilitates speech outcomes for children with cleft palate that are comparable with those for peers without CP.

Difference in lateral cephalogram of the male patients with Uygur and Han OSAHS

Objective:To investigate the difference of lateral cephalogram, PSG, BMI in Uygur and Han OSAHS male patients. Method:OSAHS male patients with 33 Uygur cases and 42 Han cases,30 normal Uygur cases and 36 normal Han cases were taken as control.Lateral cephalogram of upright position in waking state, then comparecraniofacial strcture parameters and PSG dates, etc. Result:Patients in OSAHS group and normal group had significant differences in the MP-H, PAS, PNS-P, BMI (P<0.05), the Uygur healthy men and Uygur male OSAHS patients had significant difference in the ANB° (P<0.05). The difference was statistically significant in PNS-P, MP-H and BMI in Uygur and Han OSAHS male patients (P<0.05). Conclusion:The differences in airway plane, hyoid position and length of soft palate and weight were significantly different between healthy men and OSAHS men. Han OSAHS male patients and Uygur male patients had significant differences in Hyoid position, length of the soft palate and weight. Lateral cephalogram can judge blocking site of upper airway and provide opration plan.

Analysis of Fetal Palate to Assist Pre-natal Ultrasound.

Cleft palate is one of the major facial congenital malformation in newborns. Pre-natal detection of this malformation is limited to detection of clefting of hard palate but isolated soft palate clefting still remains challenge for sonologists. As Indian literature is limited present study was attempted to provide dimensions and position of fetal palate by digitized images. To study dimensions, position and differences in parameters between second and third trimester fetuses. Median sagittal section of 32 formalin fixed fetuses was selected from the Department of Anatomy, St John's Medical College, Bangalore, Karnataka, India. Anatomical landmarks-The Nasion (N), Sellaturcica (S), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), tip of Uvula (U) were marked on sections. Length of hard palate (from ANS to PNS), Length of soft palate (from PNS to U), Hard palate/soft palate angle was defined. The anterior position of soft palate and its posterior position in relation to anterior cranial base were marked as N-S-PNS and N-S-U angle, respectively. The measurements were acquired directly from the digitized images using ImageJ software. Statistical analysis was done using SPSS 16. The mean values of ANS-PNS and PNS-U were 23.59±3.69mm and 14.39±2.70mm, respectively. The mean values of hard palate/soft palate angle, N-S-PNS and N-S-U angle were 144.720±11.11,51.150±9.09 and 93.370±9.58, respectively. Significant difference was noted between trimesters for length of hard and soft palate but not for palatal angles. During Pre-natal assessment of cleft palate, it is important for sonologist to keep in mind that the dimensions of palate proportionately increased in last two trimesters while the position remains constant.

An Innovative Approach to Evaluate the Morphological Patterns of Soft Palate in Oral Submucous Fibrosis Patients: A Digital Cephalometric Study.

Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting mucosa and submucosa of oral cavity and soft palate. The present study aimed to evaluate the morphology of soft palate in normal individuals and OSMF patients using lateral cephalometry and to compare and correlate these variants of soft palate with different stages of OSMF. 100 subjects were included in the study, who were divided into two groups. Group I included 50 subjects with clinical diagnosis of OSMF and Group II included 50 normal subjects (control group). Using digital lateral cephalometry, velar length and width were measured and soft palatal patterns were categorized based on You et al.'s classification. Leaf and rat-tail patterns of soft palate were predominant in control group, whereas butt and crook shaped variants were more in study group. Anteroposterior (A-P) length of soft palate was significantly greater in stage I OSMF, while superoinferior (S-I) width was greater in stage III OSMF. Interestingly, a negative correlation was observed in staging of OSMF and A-P dimensions. As the staging of OSMF advances, the A-P length of soft palate decreases, but S-I width increases.

Does cleft palate repair reduce the incidence of middle ear pathology?

Introduction: In an infant, cleft palate usually affects his/her feeding, speech, eustachian tube, and middle ear physiology. The incidence of otitis media with effusion is particularly very high in the children having cleft palate. Repair of cleft palate is believed to reduce this incidence. Objective: This study was conducted to assess the effect of cleft palate repair on middle ear physiology. Methodology: The study sample was divided into two groups: Group A consists of patients who are 6 years and older with unrepaired cleft palate and Group B of the patients whose cleft palate were repaired before the age of 2 years and completed at least 4 years after surgery. There were thirty patients in each group. All of them were evaluated clinically, by otoscopy and tympanometry. Clinical assessment included examination of the palate in terms of the presence of scarring, fistula, length of soft palate (visual assessment only), mobility of the soft palate, and speech scoring by Pittsburgh weighted speech score. Results: About 21% of operated patients had velopharyngeal incompetence. Thirty-four ears (56.6%) in Group A and 24 ears (40.6%) in Group B had normal otoscopy finding. Normal tympanogram (Type A curve) was found in exactly similar proportion of ears examined in both the groups (20% each). Conclusion: Early repair of cleft palate did not have any beneficial effect on middle ear pathology.

Characterization of Upper Air Way Tract in Snoring and Non-Snoring Patients: A CT Based Study

Snoring is part of the spectrum of sleep disordered breathing. The patients with snoring should be evaluated for nasal airway obstruction. In this study, the upper air way tract was characterized in snoring patients and compared with none snoring using a quantify method for the corresponding anatomic upper air way (UA) parameters examined by Computerized Tomography (CT). Two hundred Asian patients undergoing CT scanning for head and neck were included and were divided into two groups (snoring group [n = 127] and non-snoring group [n = 73]) (mean age: 44.8 ± 15.9 years and 26.2 ± 7.0). Total 8 parameters were measured on sagital reconstructed CT images for each subject. The differences in neck circumference (NC), linear distance between mandibular plane and hyoid bone (Mp-H), upper airway length (UAL), the maximum thickness of the soft palate (SP max), soft palate length (PNS-U), linear distance between anterior and posterior nasal spine (ANS-PNS), retroglosal width (RS), retroplatal width (RP) between the snoring and non-snoring groups were compared statistically using independent sample t-test. Results showed that the NC, UAL, and SP max were significantly higher in snoring group; however RP was found to be significantly lower. Inferior positioning of hyoid bone gives longer measurement for MP-H. In snoring group UAL was found to be significantly different at p ≤ 0.000 between the two genders. All the measured variables showed no significant differences in respect to age. UA CT quantitative features play an important role in the characterization of the anatomy and are compared between snoring patients and non-snoring subjects.

Anthropometric Analysis of the Velopharynx and Related Craniometric Dimensions in Three Adult Populations Using MRI.

The purpose of this study is to examine effects of sex, race, and craniometry among three distinct racial groups of adults with normal velopharyngeal anatomy and to determine whether craniofacial structures could be used to predict velopharyngeal structures. A total of 88 adults across three racial groups including white, black, and Asian (Japanese) participated. Magnetic resonance images were obtained using a high-resolution, three-dimensional anatomical scan. Measurements were obtained on the levator veli palatini muscle, velum, and craniofacial structures. Head circumference was used as a covariate to control the effect of overall cranial size on the analyses. Palate height, linear cranial base, and face height and width vary based on sex, with men demonstrating larger values compared with women. Linear base values, cranial base angle, and face width vary significantly based on race, with Japanese subjects showing the smallest anterior to posterior measures and larger face-width values. Levator muscle measures, excluding angle measures, vary significantly (P < .0001) based on sex. There was no statistically significant difference (P > .05) among racial groups in the levator muscle measures. Velar length and thickness varied significantly based on race and sex. This is the first study to examine the interaction of race and sex on levator muscle morphology. In spite of the differences in velar dimensions, no significant differences were found in muscle size, specifically the levator veli palatini, which is contained within the velum.

A Focus on Variation in Morphology of Soft Palate Using Cone-Beam Computed Tomography with Assessment of Need's Ratio in Central Madhya Pradesh Population.

Soft palate is an anatomical structure that helps in modifying the quality of voice and to breathe while swallowing. Through the variants and shapes of the soft palate, we can assess the age and gender of an individual. The aim of the present study was to investigate the variation in morphology of soft palate and to find its association with the Need's ratio, Velar Length (VL), Velar Width (VW) and Pharyngeal Depth (PD), in age groups and gender using CBCT in Central Madhya Pradesh population. The study sample consisted of 121 CBCT scans of individuals aged between 15 to 45 years. These scans were retrieved from the Department of Oral Radiology. The velar morphology on CBCT was examined and grouped into six types. The results obtained were subjected to a statistical analysis to find the association between variants of the soft palate with gender and different age groups. ANOVA and Z-test were used for statistical analysis. The p≤0.05 was considered as significant while p≤0.001 was considered as highly significant. The most frequent type of soft palate was rat tail shaped. The mean VL and VW values were significantly higher in males while PD and Need's ratio were higher among females, insignificantly associated with the types of soft palate. A significant association was observed between the mean VL and VW with various age groups, showing an increase in values with an increase in age. A variation in morphology of soft palate plays an important role in the assessment of velopharyngeal closure and in diagnosing obstructive sleep apnoea individuals.

Dimensional and volumetric analysis of the oropharyngeal region in obstructive sleep apnea patients: A cone beam computed tomography study.

Obstructive Sleep Apnea (OSA) is a potentially life-threatening condition in which there is a periodic cessation of breathing (for 10 sec or longer) that occurs during sleep in the presence of inspiratory effort. The aim of the study was to assess volumetric and dimensional differences between OSA patients and normal individuals in the upright posture. The present study was conducted on CBCT scans of 32 patients who were divided into two groups -Group I (control group) and Group II (OSA subjects). Group I consisted of 16 patients with normal airway with ESS score from 2 to 10, STOP BANG Questionnaire score of <3 and who had undergone CBCT for various diagnostic reasons. Group II had patients with ESS score >10, STOP BANG Questionnaire score of > 3, AHI index >5. Linear and angular parameters, volume and minimum cross-section area (MCA) of oropharyngeal airway, anteroposterior length and lateral width at MCA was compared amongst the groups. The oropharyngeal volume, MCA, and the anteroposterior and lateral width of the airway at MCA of the OSA subjects was significantly lesser than that of normal subjects. The length of both soft palate and tongue was significantly more in Group II. The angle between the nasopharyngeal airway and the oropharyngeal airway was significantly more obtuse in Group II. The reduction in oropharyngeal volume in OSA patients could be attributed to different anatomical and pathophysiological factors that were corroborated with the findings of the present study.

Cephalometric Analysis of the Velopharyngeal Muscular Triangle as a Possible Prognostic Factor for Velopharyngeal Closure in Submucous Cleft Palate

Objective: To elucidate the anatomical characteristics of submucous cleft palate (SMCP), we analyzed the velopharyngeal (VP) structures focusing on the relationship between the position of posterior pharyngeal wall (PPW) in the VP muscles and VP closure acquisition in SMCP patients. Methods: Cranial landmarks for cephalomatric analysis were identified in a study of two cadavers, and the area of the velopharyngeal muscular triangle (VPM-triangle), which was bordered by the origin of the levator veli palatini muscle, the origin of the palatopharyngeal muscle, and the insertion of both muscles, was defined. We then cephalometrically measured the VP structures of 14 SMCP patients (SMCP group) and the position of the PPW within the VPM-triangle. As a comparison group, 20 healthy Japanese children (control group) and 20 patients who underwent palatal repair for cleft palate (postoperative CP group) were enrolled. In addition, we analyzed the correlation between VP closure and position of the PPW within the VPM-triangle in the SMCP group. Results: The SMCP group exhibited shorter velar length, greater pharyngeal depth and greater height. In the control and postoperative CP groups, the part of the PPW within the VPM-triangle was located near to the motion vector of the levator veli palatine muscle, while it was located significantly more posteriorly in the SMCP group. The PPW of the poor VP closure subgroup of the SMCP group tended to locate more posteriorly than those of the favorable VP closure subgroup and the control group. Conclusions: The VP forms of the SMCP group were characterized by a shorter velum, a deeper and higher pharynx, and a more posterior PPW than the motion vector of palatal muscles. A positional discrepancy of the velopharynx including the PPW position relating to the direction of the motion of the VP muscles may influence the difficulty of VP closure achievement in SMCP patients.

Magnetic Resonance Imaging of Velar Muscle Tissue Distribution in Healthy Adults.

To examine muscle tissue distribution along the length of the velum in living individuals using magnetic resonance imaging (MRI). Using the three-dimensional MRI data acquired from 10 normal white adults, two area measures including the muscular area and the total velar area were obtained from 10 oblique slices running perpendicular to velar length. A polynomial regression analysis was performed where the proportion of the muscular to the total velar area was regressed on the slice numbers running along the length of the velum. The proportion of the muscular to total velar area increased from the anterior section of the velum, reaching a maximum (33.24%) in the midsection, and decreasing in the posterior section of the velum. A third-order (cubic) polynomial function that best illustrated the proportional data (R(2) = .47) was derived. The present study demonstrated that MRI is a viable tool to examine the muscle tissue distribution of the velum in living individuals. Although the overall pattern in the muscle tissue distribution of the healthy velum was similar to that reported in previous literature based on cadaver specimens, the participants in the present study appeared to have greater muscular proportion of the velum. The muscular proportion measure derived from the healthy living individuals can be used as an additional parameter accounting for sufficient intravelar muscle mass for future studies.

Velopharyngeal Configuration Changes Following Le Fort I Osteotomy With Maxillary Advancement in Patients With Cleft Lip and Palate: A Cephalometric Study.

To describe the morphological changes of velopharyngeal components in patients with cleft lip and palate after Le Fort I osteotomy with maxillary advancement and to clarify whether the velopharyngeal morphological changes are related to the distance of maxillary advancement. Retrospective case series. Hospital and Stomatology Unit of Peking University, Beijing, China. A total of 47 patients with maxillary hypoplasia secondary to cleft lip and palate. Le Fort I osteotomy combined with bilateral sagittal split ramus osteotomy and/or genioplasty for treatment of maxillofacial deformity. The lateral cephalometric radiographs with velum at rest (n = 47) and during phonation of /i/ (n = 17) were undertaken preoperatively (T1), 1 week postoperatively (T2), and at least 6 months postoperatively (T3). Some measure indices of velopharyngeal configuration were collected and analyzed. The average maxillary advancement distance was 4.08 ± 1.58 mm. The velar length, velar angle, and nasopharyngeal depth increased, but velar thickness decreased. The motion of the soft palate had no significant change, but the motion of the posterior pharyngeal wall and the Passavant's ridge increased significantly. No significant linear correlation was found between maxillary advancement distance and velopharyngeal configuration changes. Correction of maxillary hypoplasia by Le Fort I osteotomy with maxillary advancement increases the velopharyngeal cavity depth, which may impair velopharyngeal competence. The compensatory effects of the velopharyngeal soft tissue and posterior pharyngeal wall may alleviate this impairment to a certain extent.

Evaluation of uvuloglossopharyngeal dimensions in patients with thalassemia intermedia and major

The uvuloglossopharyngeal dimensions (UGPDs) are assumed to be affected by thalassemia major (TM). Because thalassemia intermedia (TI) is a milder form without need for blood transfusions, this study aimed to evaluate whether the UGPDs in thalassemic patients are equally affected by the two forms. The study sample comprised 52 lateral cephalograms from thalassemic patients (31 TM; 21 TI) aged 12.98 ± 1.66 years. The control group comprised 25 lateral cephalograms from non-thalassemic subjects aged 13.64 ± 1.55 years with ANB > 3°. Linear measurements including tongue length (TGL), tongue height (TGH), soft palate length, uvula thickness (UT), superior airway space, middle airway space, inferior airway space, and mandibular plane to hyoid (MP–H) were recorded using AutoCAD 2007 software. Mean TGL, TGH, and MP–H in the thalassemic patient group were significantly smaller than those in the control group (all P < 0.05). Conversely, the mean UT was significantly greater than that in the control group (P < 0.001). The mean TGH, TGL, and MP–H in the control group were significantly greater than those in the TM and TI groups and the mean UT in the control group was significantly smaller than those in the TM and TI groups (all P < 0.05). There were significant differences in some airway components (TGL, TGH, MP–H, UT) between the thalassemic patient group and the control group based on lateral cephalograms as a reliable tool. However, there were no significant differences in these measurements between TM and TI patients.