A Proof-of-Concept Application of Principal Component Analysis For Identification of Anatomical Variations in Pharyngeal Flap Patients Experiencing Persistent Velopharyngeal Insufficiency

Abstract

Cleft palates are one of the most common birth defects across the globe. The repair of cleft palates often includes the addition of a pharyngeal flap to assist with closure between the nasal and oral cavities. The failure rate of the pharyngeal flap placement is up to 30%, resulting in persistent velopharyngeal insufficiency, hyper-nasal speech, obstructive sleep apnea, and often requiring repetitive and expensive medical care. Many of these failures are caused by a lack of personalized surgical planning, using generic placement locations for the pharyngeal flaps. The generic placement of pharyngeal flaps is an insufficient method due to anatomical differences found in the patients receiving these surgeries. This study developed a proof-of-concept method for using principal component analysis to identify potential differences in anatomical shapes and compare them to clinical outcomes. An existing set of MRIs was used to identify shape variations found in patients with varying levels of velopharyngeal insufficiency. The identifications of these shape differences supported the ability to use the principal component analysis method for this kind of work. Results of this study provided the framework for future modeling projects. Further work with a larger and more homogeneous data set is needed to validate and expand on the findings made in this pilot study.