[Lateral radiographic comparison for velar movement between palatoplasty with velopharyngeal muscular reconstruction and modified Von Langenbeck's procedure].

OBJECTIVE

To verify the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velar movement through the lateral radiography.

METHODS

From October 1988 to October 2000, 62 patients with cleft palate and velopharyngeal insufficiency were treated. Of them, 32 were repaired by velopharyngeal muscular reconstruction (group A) and 30 by modified von Langenbeck's procedure (group B). The lateral radiographs and cephalometric analysis were taken. The velopharyngeal closure, velar extensibility, the angle changes of velar elevation, the distance changes of velar levator eminence based on anatomy (LEA) to velopharyngeal closure line (VCL), the varieties in LEA, the comparison of LEA and velar levator eminence based on phonation (LEP), the distance comparison between posterior nasal spine (PNS) to LEA and LEP through soft palate line (SPL) were measured.

RESULTS

During the phonation, group A was significantly greater than group B in the velopharyngeal closure rate (P<0.01), the velar extensibility (P<0.05) and the location comparison between LEA and LEP (P<0.01); group B was significantly greater than group A in velar elevation angle (P<0.05), the varieties in LEA (P<0.05). In velar rest position, the distance of LEA to VCL was greater in B group than in A group(P<0.01). There was significant difference in the distance comparison between LEA and LEP(P<0.05), difference between LEA and LEP (P<0.01) and the distance PNS-SPL-LEA and PNS-SPL-LEP(P<0.05) within group B; contrary to the results within group A (P>0.05).

CONCLUSION

The velopharyngeal muscular reconstruction in palatoplasty can result in a near normalization of anatomic measurement of velar levator muscles and improve the velar function and velopharyngeal competence. Repositioning of velar muscles in a more anatomic correct, transverse position is more important to improve the velar length and accordant velar movement with velopharyngeal muscles in functional palatoplasty. The velar angle change and velar elevation during phonation are not determinative factors for velopharyngeal competence.