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Cephalometric Analysis of the Velopharyngeal Muscular Triangle as a Possible Prognostic Factor for Velopharyngeal Closure in Submucous Cleft Palate
Masahiro Tezuka, Yuichi Tamatsu, Naoko Miura, Toshiro Kibe, Kazuhide Nishihara, and Norifumi Nakamura
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.