Sex Differences in Velopharyngeal Anatomy of 9- and 10-Year-Old Children.

OBJECTIVE: Understanding the normal anatomy of velopharyngeal (VP) mechanism and the emergence of sexual dimorphism provides valuable insights into differences of VP anatomy among males and females. The purpose of this study is to examine sex differences in VP anatomy in a large data set of 3,248 9- and 10-year-old children. METHOD: Static three-dimensional magnetic resonance imaging was used to compare five VP characteristics including velar length, velar thickness, effective velar length, levator veli palatini muscle length, and pharyngeal depth between age-matched males (n = 1,670) and females (n = 1,578). Additionally, these dimensions were used to determine the VP ratio and effective VP ratio. RESULTS: Males showed significantly larger dimensions for all VP distances and significantly lower ratios of velar length and effective velar length to pharyngeal depth (p < .05). The magnitude of these effect sizes was small to medium, with Cohen's d values ranging from 0.12 to 0.63. Additionally, the VP ratio and effective VP ratio are lower among males compared to females (p < .05). CONCLUSIONS: Results suggest the presence of sexual dimorphism in the VP mechanism among 9- and 10-year-old children. These findings emphasize the necessity of using different normative data for males and females when making comparisons to patients with cleft palate.

Can Velopharyngeal MRI be Used in Individuals with Orthodontic Devices?

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.

Impact of Insurance Status on Initiation of Breast Milk Feeding Among Infants With CL ± P.

To evaluate rates of breast milk feeding among infants with cleft lip with or without cleft palate (CL ± P) enrolled in Medicaid compared to Private Insurance/Self-Pay.This was a population-based retrospective cohort study.The 2018 US National Vital Statistics System-Natality component (NVSS-N) was used to examine nationwide birth certificate data.Infants with cleft lip with or without cleft palate and either Medicaid or Private Insurance/Self-Pay were included.Breast milk feeding rates among infants with CL ± P, as a function of insurance status.Chi-square tests of independence revealed that of 896 infants with CL ± P and insured by Medicaid, 527 (58.8%) were breast milk fed at discharge. Of 865 infants with CL ± P and insured by Private Insurance/Self-Pay, 621 (71.8%) were breast milk fed at discharge. Using logistic regression models and controlling for baseline demographic differences, results indicated that infants with CL ± P in the Medicaid group had reduced odds of breast milk feeding compared to the Private Insurance/Self-Pay group (OR = 0.08; 95% CI 0.56, 0.96).Breast milk support services are often necessary for the initiation of breast milk feeding among infants with CL ± P. However, these resources are likely not as readily available for those enrolled in Medicaid. These results suggest that infants with CL ± P, enrolled in Medicaid, may experience reduced breast milk feeding rates due to limited resources to initiate breast milk feeding. Factors that may promote breast milk feeding among this population are discussed.

English-Only Treatment of Compensatory Speech Errors in a Bilingual Adoptee With Repaired Cleft Palate: A Descriptive Case Study.

Purpose The purpose of this clinical focus article is to provide a descriptive case study of a late-adopted, bilingual adolescent with cleft palate speech errors. Specifically, we examined the cross-linguistic generalization of remediated compensatory cleft errors, following treatment in English (second language) only. The overarching goal of this study is to gain insights into the complexity of speech intervention for the adopted population with delayed cleft palate repair. Method A 14-year-old female adopted from China with a repaired unilateral cleft lip and palate and maladaptive articulation errors underwent 55 one-hour sessions of a motor-based, speech therapy approach over a 15-month span, targeting English phonemes only. Pre-, mid-, and posttreatment evaluation included perceptual and instrumental assessment of speech and resonance. Outcome measures at each time point included perceptual speech and resonance ratings, nasometry scores, and percent consonants correct (PCC) in both English and Mandarin. Results PCC in English improved from 60% in single words and 35% in sentences pretreatment to 100% in single words and sentences during posttreatment assessment. Without direct treatment in Mandarin, PCC in Mandarin improved from 56% in single words and 50% in sentences pretreatment to 100% in single words and 99% in sentences during posttreatment assessment. Posttreatment nasometry scores decreased by 20% for the nasal sample and 17% for the oral sample compared to pretreatment. Conclusions This descriptive case study demonstrated successful remediation of cleft palate speech errors, following 15 months of treatment in a late-adopted bilingual adolescent using a motor-based therapy approach. Treatment of errors in English (second language) led to generalization of correct productions in Mandarin (first language). This study presents the potential for bilingual late adoptees to achieve intelligible speech in both languages when motor-based therapy principles are applied to intervention.

Identifying Predictors of Levator Veli Palatini Muscle Contraction During Speech Using Dynamic Magnetic Resonance Imaging.

Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women (M = 22.8 years, SD = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of "ansa." Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors (p < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin distance, velar thickness, pharyngeal depth, and velopharyngeal ratio. Significant predictors (p < .05) of maximum contraction velocity during velopharyngeal closure included mean extravelar length, intravelar length, LVP origin-to-origin distance, and velar thickness. Conclusions This study identified six velopharyngeal variables that predict LVP muscle function during real-time speech. These predictors should be considered among children and individuals with repaired cleft palate in future studies.