Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study.

OBJECTIVE: To identify quantitative and qualitative differences in the velopharyngeal musculature and surrounding structures between children with submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI) and noncleft controls with normal anatomy and normal speech. METHODS: Magnetic resonance imaging was used to evaluate the velopharyngeal mechanism in 20 children between 4 and 9 years of age; 5 with unrepaired SMCP and VPI. Quantitative and qualitative measures of the velum and levator veli palatini in participants with symptomatic SMCP were compared to noncleft controls with normal velopharyngeal anatomy and normal speech. RESULTS: Analysis of covariance revealed that children with symptomatic SMCP demonstrated increased velar genu angle (15.6°, P = .004), decreased α angle (13.2°, P = .37), and longer (5.1 mm, P = .32) and thinner (4 mm, P = .005) levator veli palatini muscles compared to noncleft controls. Qualitative comparisons revealed discontinuity of the levator muscle through the velar midline and absence of a musculus uvulae in children with symptomatic SMCP compared to noncleft controls. CONCLUSIONS: The levator veli palatini muscle is longer, thinner, and discontinuous through the velar midline, and the musculus uvulae is absent in children with SMCP and VPI compared to noncleft controls. The overall velar configuration in children with SMCP and VPI is disadvantageous for achieving adequate velopharyngeal closure necessary for nonnasal speech compared to noncleft controls. These findings add to the body of literature documenting levator muscle, musculus uvulae, and velar and craniometric parameters in children with SMCP.

Minimal scar repair of unilateral cleft lip.

BACKGROUND: Most conventional repairs for unilateral cleft lip are based on the notion that the two joined edges of skin should be the same length. To this end, they incorporate designs that include darts, cutbacks, rotation flaps, and other strategies to match the length of the two segments. As unequal skin edges are routinely joined surgically, it should be unnecessary to incorporate maneuvers in unilateral cleft lip repair to match the segment lengths. A repair that places the scar along the philtral ridge was developed. This eliminates scars that deviate from the aesthetic subunits. METHODS: Since 1982, a procedure has been used for unilateral cleft lip repair that incorporates the Kernahan functional muscle repair with a vertical skin closure, a white roll flap, and a dart at the nasal sill. The results of this lip repair, which does not intentionally match the segment lengths, are reviewed. Photographs of 10 consecutive patients who had their unilateral cleft lips repaired with this technique are presented for critical analysis. The mean age at operation was 15.4 weeks (range, 8 to 30 weeks). The mean postoperative period for the presented photographs was 66 months (range, 31 to 87 months). All of the patients healed without complications, and no revisions were performed. RESULTS: Preoperative and postoperative photographs of 10 consecutive patients demonstrate that normal lip length can be achieved without scars outside of the aesthetic subunits of the lip. CONCLUSION: The unilateral cleft lip deformity is repairable, with excellent results, without incorporating maneuvers to match the lengths of the opposing cut edges.