A. Brief resume of the intended work: Need for the study



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A. Brief resume of the intended work:

Need for the study:
Secondary treatment such as placement of a speech appliance or pharyngeal flap operation is necessary in patients with velopharyngeal incompetence after palatal repair.The level of velopharyngeal closure should be taken into consideration when planning secondary treatment of patients with repaired cleft palate.
In patients with repaired cleft palate ,the posterior maxilla is located more posterosuperiorly.Hence the level of velopharyngeal closure in repaired cleft palate patients maybe different from normal individuals.This study is to confirm the usefulness of palatal plane as an indicator for evaluating the level of velopharyngeal closure.
Review of Literature:
A study investigated the possible differences in how velopharyngeal closure is attained by normal subjects during various activities. The findings of this investigation are discussed in terms of their implications for assessment and treatment of velopharyngeal inadequacy in individuals with cleft palates. The study emphasized that mechanisms utilized by individuals with incompetent structures may be quiet different from those observed in normal subjects

A cephalometric assessment of the nasopharynx and its adjacent structures was carried out in two experimental groups of 5 year old male patients with unilateral cleft lip and palate. The first group of individuals did not have surgery and the second group had individuals who were atleast one year post palatoplasty with primary pharyngeal flap. Both these group of individuals showed a reduction in the nasopharyngeal bony framework related to the posterior position and decreased posterior height of the maxilla without hypertrophy of the adenoids further suggesting velopharyngeal incompetence.2


A study compared the patterns of velopharyngeal growth in children with cleft lip and/or palate. Those who had velopharyngeal competence and acceptable speech are compared with those who presented with velopharyngeal incompetence. It was noticed that mainly two factors contributed to velopharyngeal incompetence at a later date. They were the length ,function and posture of the the soft palate and the depth and width of the nasopharynx .3


A study was conducted on children to compare the cephalometric growth charecterestics of the nasopharyngeal structures between unilateral cleft lip and palate and noncleft controls. The authors concluded that growth inhibition at the posterior maxilla results in morphological disharmony of upper nasopharyngeal structures and this could be a potential factor for the reappearance of velopharyngeal incompetence at a later age.4

A study was done to characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence following repushback surgery for cleft palate. The study concluded that the craniofacial morphology of patients with persistant velopharyngeal insufficiency was characterized by short palate, wide based and counter clockwise rotated pharyngeal triangle and posteriorly and superiorly positioned posterior pharyngeal wall. These might be contributory factors for the prediction of velopharyngeal closure function before repushback sugery for cleft palate5.



Objectives of the study:

To determine whether palatal plane is a useful indicator for evaluating the level of velopharyngeal closure

To identify the changes that occur with growth in the vertical relationship between palatal plane and level of velopharyngeal closure.

As an aid in the secondary treatment of repaired cleft palate patients.




B. Materials and methods :
Source of data:

In vivo study will be conducted at Dept of Oral & Maxillofacial Surgery A.B.Shetty Memorial Institute Of Dental Sciences, Deralakatte, Mangalore & Nitte Meenakshi Craniofacial Centre at the K.S. Hegde Medical Sciences Complex. 30 Patients with repaired unilateral cleft lip and palate (cleft group) and 30 controls without cleft(control group) will be selected.



Method of collection of data (including sampling procedure, if any)

The study is planned as follows :

1. Selection of subjects ,30 in cleft group and 30 in control group.

2. lateral cephalograms taken with subjects at rest, and during blowing and phonation of /a/

to be used for data analysis

3. A system in which N-S line is made the X axis and a perpendicular to the X-axis through the sella is the Y axis are to be used for the measurement of co ordinates. Cephalometric landmarks are also to be established to evaluate the level of palatal plane

and velopharyngeal closure involving the velum and posterior pharyngeal wall

4. In addition attention to be paid to the vertical relationship between the palatal

Plane and the level of velopharyngeal closure and ,and the significance of

differences has to be assessed by student’s t test.



Inclusion criteria:

30 cases with repaired unilateral cleft lip and palate and 30 controls without cleft are to be selected for the study.

The case and controls are to be within the age group of 4 to 17 years

Complete velopharyngeal closure to be confirmed in all subjects in both groups during swallowing,phonation and blowing using a nasopharyngeal endoscope.



Exclusion criteria:

All subjects beyond the age group of 17 years are to be excluded from the study.

Patients who have undergone secondary repair of palate are not included

Patients with velopharyngeal insufficiency are also excluded



Does the study require any investigations or interventions to be

conducted on patients or other humans or animals?

Yes




Has the ethical clearance been obtained from your institution in

case of 7.3?

Yes (letter enclosed).



C. List of References:

1) Moll KL. A cinefluorographic study of velopharyngeal function in normals during various activities. The Cleft palate- Craniofacial Journal 1974;2;112-122


2) Smahel Z,mullerova I .Nasopharyngeal charecterestics in children with cleft lip and

palate. The Cleft palate- Craniofacial Journal 1992;29;282-286.


3) Mazaheri M ,Athanasiou AE,Long RE jr.comparison of velopharyngeal growth patterns between cleft lip and /or palate patients requiring or not requiring pharyngeal flap surgery. The Cleft palate- Craniofacial Journal 1994;31;452-460.
4) Wada T,Satoh K,Tachimura T,Tatsuta U,comparison of nasopharyngeal growth between patients with clefts and non cleft controls. The Cleft palate- Craniofacial Journal 1997;34;405-409.

5) Norifumi Nakamura,Yuko Ogata,Kyoko Kunimitsu .Velopharyngeal morphology of patients with persistant velopharyngeal incompetencefollowing repushback surgery for cleft palate. The Cleft palate -Craniofacial journal 2003;40;612-617
Directory: cdc -> onlinecdc -> uploads
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uploads -> Postgraduate student department of oral and maxillofacial pathology
uploads -> DR. neeraj goyal, post graduate student, sri hasanamba dental college and hospital
uploads -> Department of prosthodontics, D. A. P. M. R. V. Dental college and hospital
uploads -> Karnataka annexure –ii proforma for registration of subjects for dissertation
uploads -> Proforma for registration of subjects for dissertation
uploads -> Karnataka, bangalore. Annexure- II proforma for registration of subjects for dissertation
uploads -> Karnataka, bangalore
uploads -> Proforma for registration of subjects for dissertation


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