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

2020 ◽  
Vol 63 (5) ◽  
pp. 1317-1325 ◽  
Author(s):  
Katelyn J. Kotlarek ◽  
Catherine M. Pelland ◽  
Silvia S. Blemker ◽  
Michael S. Jaskolka ◽  
Xiangming Fang ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Future Research ◽  
Imaging Protocol ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
History Of ◽  
Magnetic Resonance Imaging Protocol ◽  
The Impact

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

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

2020 ◽  
pp. 105566562095474 ◽  
Author(s):  
Graham C. Schenck ◽  
Jamie L. Perry ◽  
Mary M. O’Gara ◽  
Amy Morgan Linde ◽  
Mitchell F. Grasseschi ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Imaging Study ◽  
The Body ◽  
Analysis Of Covariance ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Levator Veli Palatini ◽  
Submucous Cleft Palate ◽  
Α Angle ◽  
Normal Speech

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.

scholarly journals Evaluation of the Symmetry of the Levator Veli Palatini Muscle and Velopharyngeal Closure Among a Noncleft Adult Population

2020 ◽  
pp. 105566562096126
Author(s):  
Neda Tahmasebifard ◽  
Charles Ellis ◽  
Kathrin Rothermich ◽  
Xiangming Fang ◽  
Jamie L. Perry
Keyword(s):  
Adult Population ◽  
Levator Muscle ◽  
Levator Veli Palatini ◽  
Visualization Software ◽  
Velopharyngeal Closure ◽  
Nonsignificant Difference ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Impact ◽  
Typical Range

Purpose: The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of the observed asymmetry on velopharyngeal closure. A second objective is to report normative length and thickness of the levator veli palatini muscle among adults with typical velopharyngeal anatomy. Method: Magnetic resonance imaging (MRI) data and Amira 5.5 Visualization software were used to evaluate the levator veli palatini muscle among 89 participants with typical velopharyngeal anatomy. Flexible nasopharyngoscopy was used to determine the function of velopharyngeal closure among 39 of the 89 participants with typical velopharyngeal anatomy to examine the functional impact of observed asymmetry. Results: Matched paired t tests demonstrated a nonsignificant difference between the length and thickness of the right and left levator muscle. The mean difference between the right and left length of the levator muscle was 2.28 mm but ranged from 0.09 mm to 10.37 mm. In all cases where individuals displayed asymmetry in the levator muscle through MRI, there was no observed impact on the symmetry of velopharyngeal closure. Discussion: This study suggest that differences in the right and left levator veli palatini muscle are not significant among individuals without cleft palate. However, among individual cases where asymmetry was sizeable, there was no direct impact on the closure pattern. This may suggest there are multiple factors that contribute to asymmetrical velopharyngeal closure that are beyond the level of the levator veli palatini muscle.

Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures

2020 ◽  
pp. 105566562098133
Author(s):  
Alyssa Fritz ◽  
Diana S. Jodeh ◽  
Fatima Qamar ◽  
James J. Cray ◽  
S. Alex Rottgers
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Cleft Palate ◽  
Fistula Repair ◽  
Old Patients ◽  
Oronasal Fistula ◽  
Patient Reported ◽  
History Of ◽  
The Impact

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

373 Historical Use of Substances for Insomnia Impacts Current Beliefs about Hypnotic Medications

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A148-A149
Author(s):  
Jessica Dietch ◽  
Norah Simpson ◽  
Joshua Tutek ◽  
Isabelle Tully ◽  
Elizabeth Rangel ◽  
...  
Keyword(s):  
Prescription Medication ◽  
Stepped Care ◽  
Future Research ◽  
Prescription Medications ◽  
Over The Counter ◽  
Multiple Treatment ◽  
History Of ◽  
Study Participants ◽  
Beliefs About Medications ◽  
The Impact

Abstract Introduction The purpose of the current study was to examine the relationship between current beliefs about hypnotic medications and historical use of prescription hypnotic medications or non-prescription substances for sleep (i.e., over the counter [OTC] medications, alcohol, and cannabis). Methods Participants were 142 middle age and older adults with insomnia (M age = 62.9 [SD = 8.1]; 71.1% female) enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. Participants reported on history of substances they have tried for insomnia and completed the Beliefs about Medications Questionnaire-Specific with two subscales assessing beliefs about 1) the necessity for hypnotics, and 2) concerns about potential adverse consequences of hypnotics. Participants were grouped based on whether they had used no substances for sleep (No Subs, 11.6%), only prescription medications (Rx Only, 9.5%), only non-prescription substances (NonRx Only, 26.6%), or both prescription and non-prescription substances (Both, 52.3%). Results Sixty-one percent of the sample had used prescription medication for sleep and 79% had used non-prescription substances (74% OTC medication, 23% alcohol, 34% cannabis). The greater number of historical substances endorsed, the stronger the beliefs about necessity of hypnotics, F(1,140)=23.3, p<.001, but not about concerns. Substance groups differed significantly on necessity beliefs, F(3,1)=10.68, p<.001; post-hocs revealed the Both group had stronger beliefs than the No and NonRx Only groups. Substance groups also differed significantly on the concerns subscale, F(3,1)=6.68, p<.001; post-hocs revealed the NonRx Only group had stronger harm beliefs than the other three groups. Conclusion The majority of the sample had used both prescription and non-prescription substances to treat insomnia. Historical use of substances for treating insomnia was associated with current beliefs about hypnotics. Individuals who had used both prescription and non-prescription substances for sleep in the past had stronger beliefs about needing hypnotics to sleep at present, which may reflect a pattern of multiple treatment failures. Individuals who had only tried non-prescription substances for sleep may have specifically sought alternative substances due to concerns about using hypnotics. Future research should seek to understand the impact of treatment history on engagement in and benefit from non-medication-based treatment for insomnia. Support (if any) 1R01AG057500; 2T32MH019938-26A1

scholarly journals Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
L. M. Paulson ◽  
C. J. MacArthur ◽  
K. B. Beaulieu ◽  
J. H. Brockman ◽  
H. A. Milczuk
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Speech Intelligibility ◽  
Velopharyngeal Insufficiency ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
History Of

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate.Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance.Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population.Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair

2021 ◽  
pp. 105566562110295
Author(s):  
Åsa C. Okhiria ◽  
Fatemeh Jabbari ◽  
Malin M. Hakelius ◽  
Monica M. Blom Johansson ◽  
Daniel J. Nowinski
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
The Impact ◽  
Nasal Emission

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation in Cleft Palate Subjects

1995 ◽  
Vol 32 (5) ◽  
pp. 376-381 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Cleft Palate ◽  
Air Pressure ◽  
Levator Muscle ◽  
Emg Activity ◽  
High Activation ◽  
Levator Veli Palatini ◽  
Activation Level ◽  
High Activation Level ◽  
Intraoral Air Pressure ◽  
Total Activation

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed In relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.

scholarly journals The Efficacy of Ethnic Stacking: Military Defection during Uprisings in Africa

2019 ◽  
Vol 5 (4) ◽  
pp. 695-702 ◽  
Author(s):  
Julien Morency-Laflamme ◽  
Theodore McLauchlin
Keyword(s):  
Large Scale ◽  
Armed Forces ◽  
Future Research ◽  
Group Loyalty ◽  
Limited Support ◽  
History Of ◽  
Group Members ◽  
Using Data ◽  
The Cost ◽  
The Impact

Abstract Does ethnic stacking in the armed forces help prevent military defection? Recent research, particularly in Africa and the Middle East, suggests so; by favoring in-groups, regimes can keep in-group soldiers loyal. In-group loyalty comes at the cost of antagonizing members of out-groups, but many regimes gladly run that risk. In this research note, we provide the first large-scale evidence on the impact of ethnic stacking on the incidence of military defection during uprisings from below, using data on fifty-seven popular uprisings in Africa since formal independence. We find clear evidence for the downside: ethnic stacking is associated with more frequent defection if out-group members are still dominant in the armed forces. We find more limited support for the hypothesized payoff. Ethnic stacking may reduce the risk of defection, but only in regimes without a recent history of coup attempts. Future research should therefore trace the solidification of ethnic stacking over time.

Winning and Losing in Federal Sector Dispute Resolution

1994 ◽  
Vol 23 (2) ◽  
pp. 301-319 ◽  
Author(s):  
Charles G. Smith
Keyword(s):  
Dispute Resolution ◽  
Federal Agencies ◽  
Background Information ◽  
Future Research ◽  
Federal Sector ◽  
Final Offer ◽  
Labor Agreement ◽  
History Of ◽  
The Impact ◽  
Do So

This paper examines the binding decisions of the Federal Service Impasses Panel. (Panel) The Panel has the authority to mediate and ultimately decide the terms of a labor agreement should the federal agencies and labor unions be unable to do so bilaterally. This paper presents descriptive data on who wins and who loses with the Federal Service Impasses Panel. Background information on the history of dispute resolution machinery in the federal government is outlined. The data was collected from a content analysis of 307 of 311 binding cases decided by the Panel from 1/79 through 7/87. The paper chronicles the types of procedures used by the Panel, the nature of issues at impasse and who wins. Also, the number and types of arguments used by the parties in support of their respective positions with the Panel are examined. A number of conclusions are drawn from the analysis. (1) The Panel uses a number of different types of dispute machinery including conventional and final offer procedures. (2) Management won almost sixty percent of all issues brought before the Panel (3) Labor and management tend to use a variety of different arguments to support their positions. (4) Neither labor nor management appeared very interested in the impact of their proposals on the general public. Future research may wish to investigate the specific reasons for management success.

Change in Levator Veli Palatini Muscle Activity for Patients with Cleft Palate in Association with Placement of a Speech-Aid Prosthesis

2002 ◽  
Vol 39 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Takashi Tachimura ◽  
Kanji Nohara ◽  
Yoshinori Fujita ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Pressure Change ◽  
Mean Value ◽  
Emg Activity ◽  
Reserve Capacity ◽  
Activity Levels ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Closure ◽  
The Mean

Objective: The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence. Design: Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place. Participants: The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis. Results: With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers. Conclusion: Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the noprosthesis condition.

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