Jamie L. Perry

Objective The purpose of this study was to determine the anatomical differences among selected individuals with a cleft palate repaired using “The Buccal Flap Approach” during primary palatoplasty compared to aged-matched participants without cleft palate. Design Observational, prospective. Setting Two regional hospitals. Participants A total of 30 adult males consisting of 15 adults born with cleft palate who received the Double Opposing Z-Plasty plus Buccal Flaps (DOZP + BF) repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery and 15 adults without a history of cleft palate. Interventions All participants underwent MRI to visualize anatomy. Main Outcome Measures Ten velopharyngeal and craniofacial anatomical measures. Results No statistically significant differences between groups were observed for velar thickness, velar length, pharyngeal depth, NSBa angle, SNB angle, or levator veli palatini length. Individuals with the DOZP + BF presented with a greater effective velar length (p < .001), greater effective VP ratio (p < .001), smaller SNA angle (p < .001), and smaller maximal velar stretch (p < .001) compared to the control participants. Conclusions This study suggests that adult males who received the DOZP + BF repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery present with a longer effective velar length and larger effective VP ratio in comparison to the non-cleft group. Future research is needed to compare patients with and without favorable outcomes from multiple surgical types to fully understand how surgical techniques alter the anatomy.

Objective To evaluate the influence of common pediatric orthodontic appliances on velopharyngeal (VP) MRI and to compare MR image sequences to determine if sequence parameters impact the visibility of key VP structures commonly assessed in clinical VP MRI. Design Participants undergoing orthodontic treatment completed a VP MRI study. Level of distortion caused by orthodontic devices on 8 anatomical sites of interest and using variable MRI sequences was evaluated. Setting Single institution Participants Nineteen participants undergoing orthodontic treatment. Main Outcome Level of distortion caused by metal artifacts and MR sequence used. Results The results of this study demonstrate that appliances such as hyrax palatal expanders and braces with stainless steel brackets are acceptable for a VP MRI, while class II corrector springs are not recommended. The HASTE MRI sequence with 2D imaging techniques should be utilized if the child has orthodontic devices, while FSE and 3D imaging techniques are not recommended. The presence of wire spring coils and molar bands are likely to not to interfere with the MRI evaluation. Conclusions Findings from this study suggest that the presence of orthodontic appliances does not hinder visualization of all velopharyngeal structures during an MRI. Therefore, careful consideration must be made prior to disqualifying or recommending patients for VP MRI.