Normative Velopharyngeal Data in Infants: Implications for Treatment of Cleft Palate

Abstract

Identifying normative data related to velopharyngeal muscles and structures may have clinical significance for infants born with cleft palate, especially as they relate to selection of surgical intervention and post-surgical outcomes. Previous studies suggest that patients whose anatomy post-surgically is dissimilar to that of their normative counterparts are at risk for hypernasal speech. However, studies have not documented what constitutes “normal” anatomy for the clinically relevant population—that is, the infant population. The purpose of this study is to examine an MRI database (n = 29) related to normative velopharyngeal structures and provide a preliminary comparison to two selected patients with repaired cleft palate. Twenty-nine healthy infants between 9-23 months of age (Mean = 15.2 months) with normal craniofacial and velopharyngeal anatomy were recruited to participate in this study. Normative data were compared to two infants with repaired cleft palate between 13-15 months of age (Mean = 14 months). Quantitative craniometric and velopharyngeal measures from the sagittal and oblique coronal image planes were collected. Variables of interest included: levator muscle, velum, and craniometric measures. Females demonstrated significantly larger intravelar segments compared to males. White infants demonstrated significantly larger levator muscles compared to non-white infants. Infants with repaired cleft palate demonstrated increased overall levator muscle length and levator extravelar length compared to infants with normal velopharyngeal anatomy. Data from the present study provide a normative database for future investigators to utilize as a comparative tool when evaluating infants with normal and abnormal velopharyngeal anatomy.