Morphological characterization of the levator veli palatini muscle in children born with cleft palates

Objective: The aim of this study was to analyze, morphologically and bioche mically, one of the soft palate muscles, the levator veli palatini (LVP), i n children born with cleft palate. Subjects and Methods: Biopsies were obtained from nine male and three femal e infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for compariso n. The muscle morphology, fiber type and myosin heavy chain (MyHC) composit ions, capillary supply, and content of muscle spindles were analyzed with d ifferent enzyme-histochem Ica[, immunohistochemical, and biochemical techni ques. Results: Compared with the normal adult subjects, the LVP muscle from the i nfantile subjects with cleft had a smaller mean fiber diameter, a larger va riability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infant ile subjects with cleft LVP either lacked muscle tissue or contained only a small amount. Conclusions: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might b e related to different stages in maturation of the muscles, changes in func tional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue In some of the cleft biopsies offers one possible ex planation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.