A FIBERSCOPIC ANALYSIS OF VELOPHARYNGEAL MOVEMENT BEFORE AND AFTER PRIMARY PALATOPLASTY IN CLEFT-PALATE INFANTS

There have been few studies done on the abnormal function of velophary ngeal muscles in unrepaired cleft palate infants. To examine and asses s velopharyngeal movement before primary palatoplasty offers supposedl y any valuable information for the successful operation and the restor ation of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatopl asty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrep aired cleft palate infants when crying or strangulation reflex occurre d: (1) posterior movement type (10 cases, 38.5 percent),where the soft palates moved only posteriorly and cephalically and did not move medi ally; (2) medial movement type (10 cases, 38.5 percent), where the sof t palates moved only medially and did not move posteriorly or cephalic ally; and (3) posteromedial movement type (6 cases, 23.0 percent), whe re the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into th ree patterns: (1) the soft palate type, in which the soft palate mainl y operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) th e mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velo pharyngeal movement before and after primary palatoplasty in cleft pal ate infants. In total, 10 of 16 cleft palate infants with the posterio r movement type or posteromedial movement type, in which posterior mov ement of the soft palates was observed before primary palatoplasty, po stoperatively showed the soft palate type of velopharyngeal closure. O n the other hand, only 2 of 10 cleft palate infants with the medial mo vement type, in which the soft palates did not move posteriorly but me dially before primary palatoplasty, postoperatively showed the soft pa late type of velopharyngeal closure. The Fisher's exact probability te st clarified that cleft palate infants with the posterior movement typ e or posteromedial movement type were more likely to show postoperativ ely the soft palate type of the velopharyngeal closure compared with t hose with the medial movement type (p = 0.051). This is the first tria l to examine velopharyngeal movement in unrepaired cleft palate infant s. Our findings indicate the probability that velopharyngeal closure m echanism in repaired cleft palate infants is able to be predicted by v elopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movemen t and postoperative velopharyngeal function and speech outcome.