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.
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.
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
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