Patterns of Velopharyngeal Closure in Subjects with Repaird Cleft Palate and Normal Speech: A Multi-View Videofluoroscopic Analysis

Abstract

A review of the literature dealing with radiographic observations of the velopharyngeal closure apparatus indicates that there are essentially two categories of scientific investigations. There have been numerous studies of the patterns of closure in subjects with velopharyngeal incompetence (2, 4, 5, 6, 7, 8, 70, 74', 76, 77, 78) and studies of patterns of clOSure in normals (7, 70, 77, 73, 75). There is, however, a third category which as yet has not been explored. That is, studies of patterns of velopharyngeal closure in subjects with repaired cleft palates and normal speech. Skolnick (76, 77) and others (7, 3, 9, 73) have stressed the importance of analyzing velopharyngeal closure in terms of both velar movements and the medial movements of the lateral pharyngeal walls. Skolnick, et al. (78) regard velopharyngeal closure as basically a sphincteric mechanism, which can only be adequately described by a multi-View fluoroscopic procedure. Shprintzen, et al. (73) point out that lateral view radiographic procedures are limited since they are two dimensional representations of a three dimensional process, which can only be adequately described utilizing a minimum of two fluoroscopic projections. Shprintzen, et al. (75) described velopharyngeal closure for speech in normal adult subjects as involving the postero-superior movement of the velum, approximating to the posterior aspect of the pharyngeal walls (PAPW) at a point below the levator eminence, and the medial movement of the lateral aspects of the pharyngeal walls (LAPW) approximating to the lateral edges of the velum. The medial movements of the LAPW occurred primarily at a specific select level, resembling a shelf in the LAPW at the plane of the hard palate. This shelf-like pattern was observed for all normal subjects studied. M. Leon Skolnick, M.D. is Associate Professor of Clinical Radiology,