J Korean Soc Plast Reconstr Surg.  1998 Oct;25(7):1328-1337.

Study of cranial base structure and velopharyngeal movement in patients with submucous cleft palate using velopharyngogram

• No authors listed

Abstract

Submucous cleft palate is defined as a bifid uvula, palatal muscle diastasis, and a notch in the posterior surface of the hard palate. Since submucous cleft palate is presently felt to be of clinical relevance only in the presence of velopharyngeal inadequacy, the evaluation and diagnosis of occult submucous cleft palate are only pursued if the patient has velopharyngeal incompetency. The age for surgical correction of submucous cleft palate is one of the most important factors determining the speech outcome of surgical treatment. The available evidence suggests that earlier repairs yield better speech results than late repairs and that later treatment is associated with a higher rate of velophryngeal incompetency. But, treatment of patients with submucous cleft palate depend on the diagnosis of the velopharyngeal incompetency and therefore nearly always occurs later than the time for optimal treatment. Twenty submucous cleft palate patients aged 5 to 12 years with normal hearing and intelligence who visited Yonsei university plastic and reconstructive surgery department from January 1993 to January 1996 were evaluated as an experimental group and nineteen children aged 7 to 12 years with normal hearing and intelligence who randomly selected from the Hyosung elementary school were evaluated as a control group.In this study we analyzed the cranial base and soft tissue structures in submucous cleft palate using velopharyngogram. The results are summarized as follows: 1. The survey of the nasopharynx with submucous cleft palate indicated that the angle of cranial base was outside the range toward the obtusity considering analysis of covariance. 2. The pharyngeal angle(Ba-S-PNS) exceeds normal limits and the ratio of anteroposterior distance of nasopharynx with submucous cleft palate is larger in submucous cleft palate group considering analysis of covariance. 3. The patients with submucous cleft palate have relatively short soft palate in the neutral state and during phonation. 4. The soft palate of submucous cleft palate patients has lessened mobility in submucous cleft palate group. 5. The distance between both lateral pharyngeal wall shows shorter in submucous cleft palate group only during "Su" phonation. From these result, the submucous cleft palate patients have relatively obtuse cranial base and wide nasopharynx of deficient velum with limited mobility, so velopharyngeal incompetency is inevitable.

MeSH Terms

Child
Cleft Palate*
Diagnosis
Hearing
Humans
Intelligence
Nasopharynx
Palatal Muscles
Palate, Hard
Palate, Soft
Phonation
Plastics
Skull Base*
Uvula
Plastics