Clinical Significance of the Levator Veli Palatini Muscle in Velocardiofacial Syndrome Patients

Background: Anatomical variation and deficits of velocardiofacial syndrome patients are related to unsatisfactory treatment results in surgical correction of speech abnormalities. The main purpose of the article is to investigate the clinical significance of thinned levator veli palatini muscle in VCFS patients. Methods: The authors reviewed medical records of all children with velocardiofacial syndrome who received pharyngeal flap surgery between March 2007 and September 2015. Data including thickness of levator veli palatini in magnetic resonance examination; preoperative velopharyngeal gap size from nasoendoscopy; and preoperative and postoperative speech outcomes were collected. Results: Total of 36 velocardiofacial syndrome patients with preoperative objective data and postoperative speech outcomes were identified. Preoperative velopharyngeal gap showed significant correlation with thickness of levator veli palatini (correlation coefficient: 0.297/0.397, P = .02/.03) and gap size showed correlation with postoperative speech improvement (0.347/0.413, P = .04/.02). However, muscle thickness showed no correlation with speech outcomes (0.046/0.037, P = .77/.86). Conclusion: Thinned levator veli palatini muscle in velocardiofacial syndrome patients are related to widened velopharyngeal gap and production of hypernasal speech, and can give negative impact on postoperative surgical outcome of pharyngeal flap surgery.

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Evaluation of the levator veli palatini muscle thickness in patients with velocardiofacial syndrome using magnetic resonance imaging

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.04.013 ◽

2015 ◽

Vol 68 (8) ◽

pp. 1100-1105 ◽

Cited By ~ 16

Author(s):

Mikyong Park ◽

Seung Hyun Ahn ◽

Jae Hoon Jeong ◽

Rong-Min Baek

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Muscle Thickness ◽

Velocardiofacial Syndrome ◽

Resonance Imaging ◽

Levator Veli Palatini

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The Use of Magnetic Resonance Angiography prior to Pharyngeal Flap Surgery in Patients with Velocardiofacial Syndrome

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199604001-00005 ◽

1996 ◽

Vol 97 (Supplement) ◽

pp. 908-919 ◽

Cited By ~ 69

Author(s):

Robin J. Mitnick ◽

Jacqueline A. Bello ◽

Karen J. Golding-Kushner ◽

Ravelo V. Argamaso ◽

Robert J. Shprintzen

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Velocardiofacial Syndrome ◽

Flap Surgery ◽

Pharyngeal Flap

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Persistent Hypernasal Speech after Pharyngeal Flap Operation; A Report of Two Cases.

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.84.1085 ◽

1991 ◽

Vol 84 (8) ◽

pp. 1085-1089

Author(s):

Kazunori Mori ◽

Michio Kawano ◽

Iwao Honjo ◽

Eiichi Fujimura

Keyword(s):

Hypernasal Speech ◽

Pharyngeal Flap

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Blinded Speech Evaluation following Pharyngeal Flap Surgery by Speech Pathologists and Lay People in Children with Cleft Palate

Folia Phoniatrica et Logopaedica ◽

10.1159/000066153 ◽

2002 ◽

Vol 54 (6) ◽

pp. 288-295 ◽

Cited By ~ 14

Author(s):

Martin Tönz ◽

Iris Schmid ◽

Maja Graf ◽

Regula Mischler-Heeb ◽

Josef Weissen ◽

...

Keyword(s):

Cleft Palate ◽

Flap Surgery ◽

Speech Evaluation ◽

Lay People ◽

Pharyngeal Flap ◽

Speech Pathologists

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Treatment of Asymmetric Velopharyngeal Insufficiency with Skewed Pharyngeal Flap

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0287_toaviw_2.3.co_2 ◽

1994 ◽

Vol 31 (4) ◽

pp. 287-294 ◽

Cited By ~ 8

Author(s):

Ravelo V. Argamaso ◽

Gerald J. Levandowski ◽

Karen J. Golding-Kushner ◽

Robert J. Shprintzen

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Tumor Resection ◽

Velocardiofacial Syndrome ◽

Velopharyngeal Insufficiency ◽

Lateral Pharyngeal Wall ◽

Pharyngeal Wall ◽

Wall Movement ◽

Hypernasal Speech

Twenty-two patients, with hypernasal speech and asymmetric velopharyngeal insufficiency (VPI) identified preoperatively by multi-view videofluoroscopy and nasopharyngoscopy, were managed with superiorly based pharyngeal flaps skewed to the side with reduced lateral pharyngeal wall movement. Patient age ranged from 5 to 58 years. The etiology of the VPI included cleft palate with or without cleft lip, neurogenic VPI, velocardiofacial syndrome, tumor resection or latrogenic causes, submucous cleft palate, neurofibromatosis, and hemifacial microsomia. Follow-up, at 1 year and thereafter, showed resolution of VPI in all but two patients. An auxiliary flap to augment the primary flap was added on the side of diminished lateral pharyngeal wall motion which corrected the residual VPI. Three patients developed hyponasality. One was a child whose symptoms improved with time and growth. Two were adults, but the hyponasal resonance was mild and required no further Intervention. The advantage of skewing flaps is that at least one port functions adequately for ease in respiration and for drainage of secretions, thus reducing the risk of nasal obstruction. One open port also allows access for nasoendotracheal intubation should anesthetic be required for future operations.

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Incidence and Severity of Obstructive Sleep Apnea following Pharyngeal Flap Surgery in Patients with Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0312_iasoos_2.0.co_2 ◽

2002 ◽

Vol 39 (3) ◽

pp. 312-316 ◽

Cited By ~ 30

Author(s):

Yu-Fang Liao ◽

Ming-Lung Chuang ◽

Philip K.T. Chen ◽

Ning-Hung Chen ◽

Claudia Yun ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Flap Surgery ◽

Adult Group ◽

Child Group ◽

Obstructive Sleep ◽

Pharyngeal Flap ◽

Respiratory Disturbance ◽

Different Levels

Objective: To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. Subjects: Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). Design: A prospective analysis. Main Outcome Measures: An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. Results: The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p = .022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p = .435 in adults and .640 in children) or the severity (p = .325 in adults and .310 in children) of OSA in each group. Conclusions: Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.

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