Prediction of Deterioration of Velopharyngeal Function Associated with Maxillary Advancement Using Electromyography of Levator Veli Palatini Muscle

2006 ◽  
Vol 43 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Kanji Nohara ◽  
Takashi Tachimura ◽  
Takeshi Wada
Keyword(s):  
Maximal Activity ◽  
Levator Muscle ◽  
Perceptual Judgment ◽  
Levator Veli Palatini ◽  
Maximum Value ◽  
Maxillary Advancement ◽  
Total Range ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function

Objective The purpose of the present study was to examine the possibility that postoperative velopharyngeal function following maxillary advancement could be predicted using preoperative electromyography of the levator veli palatini. Design Levator muscle electromyography was recorded preoperatively during speech and blowing. Levator activity was expressed as a percentage relative to the maximum value observed throughout the experiment. Postoperative velopharyngeal function was evaluated by means of perceptual judgment and nasoendoscopy. Participants The subjects were four patients with repaired cleft palates who underwent maxillary advancement, two by osteotomy and two by distraction osteogenesis. None of the subjects presented with preoperative hypernasality, and nasoendoscopy demonstrated complete velopharyngeal closure in all subjects prior to maxillary advancement. Results Preoperative levator activity for speech of two subjects was similar to that for normal speakers (<60% of total range), and postoperative nasality and nasoendoscopic findings revealed no detectible changes. For the other two subjects, levator activity for speech exceeded 60% of the total range, similar to that of speakers with velopharyngeal incompetence. These subjects showed increased hypernasality and deteriorated velopharyngeal closure following maxillary advancement. Conclusion The deterioration of velopharyngeal function associated with maxillary advancement was demonstrated for subjects whose levator activity was at higher levels during speech in comparison with maximal activity observed during blowing, regardless of the amount of maxillary advancement. Preoperative levator muscle electromyography could be a predictor in identifying patients at higher risk of postsurgical deterioration of velopharyngeal function.

Change in Levator Veli Palatini Muscle Activity for Patients with Cleft Palate in Association with Placement of a Speech-Aid Prosthesis

2002 ◽  
Vol 39 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Takashi Tachimura ◽  
Kanji Nohara ◽  
Yoshinori Fujita ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Pressure Change ◽  
Mean Value ◽  
Emg Activity ◽  
Reserve Capacity ◽  
Activity Levels ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Closure ◽  
The Mean

Objective: The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence. Design: Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place. Participants: The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis. Results: With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers. Conclusion: Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the noprosthesis condition.

scholarly journals Asymmetry and Positioning of the Levator Veli Palatini Muscle in Children With Repaired Cleft Palate

2020 ◽  
Vol 63 (5) ◽  
pp. 1317-1325 ◽  
Author(s):  
Katelyn J. Kotlarek ◽  
Catherine M. Pelland ◽  
Silvia S. Blemker ◽  
Michael S. Jaskolka ◽  
Xiangming Fang ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Future Research ◽  
Imaging Protocol ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
History Of ◽  
Magnetic Resonance Imaging Protocol ◽  
The Impact

Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( p = .031) and effective velopharyngeal ratio ( p = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( p = .018), thickness at midline ( p = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( p = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.

Effect of Temporary Closure of Oronasal Fistulae on Levator Veli Palatini Muscle Activity

1997 ◽  
Vol 34 (6) ◽  
pp. 505-511 ◽  
Author(s):  
Takashi Tachimura ◽  
Hisanaga Hara ◽  
Hideyasu Koh ◽  
Takeshi Wada
Keyword(s):  
Muscle Activity ◽  
Hard Palate ◽  
Air Pressure ◽  
Electromyographic Activity ◽  
Cotton Swab ◽  
Levator Veli Palatini ◽  
Oronasal Fistula ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Function ◽  
Temporary Closure

Objective: The objective of this study was to clarify electromyographically the effects of closing an oronasal fistula on levator muscle activity and oral air pressure in patients with velopharyngeal incompetence and in those with adequate velopharyngeal function. Subjects: Five patients with adequate velopharyngeal function and six patients with velopharyngeal incompetence were studied. All subjects had an oronasal fistula at the anterior third portion of the hard palate in spite of primary palatal closure using palatal push-back operation. Outcome Measures: The smoothed electromyographic activity of the levator veli palatini muscle was measured with the fistula closed with a cotton swab dipped in saline and with the fistula left open. Results: Under the closed fistula condition, oral air pressure was greater than that observed under the open fistula condition irrespective of velopharyngeal function. Levator veli palatini muscle activity was significantly lower in magnitude under the condition of closure than under the open condition in the patients with adequate velopharyngeal function, whereas in those with velopharyngeal incompetence, it was not significantly changed. Conclusions: The results suggest that velopharyngeal function is affected by temporary closure of an oronasal fistula, and that the magnitude of the effect is greater for subjects with adequate velopharyngeal function than for subjects with velopharyngeal incompetence.

The Behaviors of the Levator Veli Palatine Muscle Between 2 Surgical Conditions in Dog: The Comparison of Furlow and Pushback Methods

2020 ◽  
Vol 57 (12) ◽  
pp. 1410-1416
Author(s):  
Kiyoko Nakagawa ◽  
Emiko Tanaka Isomura ◽  
Makoto Matsukawa ◽  
Ryo Mitsui ◽  
Mikihiko Kogo
Keyword(s):  
Blood Pressure ◽  
Electrical Stimulation ◽  
Beagle Dogs ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
End To End ◽  
Pressure Meter ◽  
Surgical Conditions ◽  
Velopharyngeal Function

Objective: This study was conducted to compare the velopharyngeal function among the beagle dogs which the levator veli palatini (LVP) muscles construction has been experimentally changed. Methods: Four groups of LVP muscle reconstruction were made (normal LVP, cut LVP, end-to-end sutured LVP, and overlapped-sutured LVP at the midline). Levator veli palatini contraction was induced by electrical stimulation or a hypercapnia condition to analyze the strength of the velopharyngeal closure using balloon with a blood pressure meter, and the electromyogram in those operated beagle dogs. Results: Under a hypercapnia condition, the velopharyngeal function did not differ significantly among the 4 groups in the terms of velopharyngeal pressure. The strongest closure was shown at the overlapped sutured LVP group by electrical stimulation. Conclusion: The reconstruction of overlapped sutured LVP showed the most effective closure. This study suggested that the palatoplasty should be conducted along the overlapped LVP (like Furlow method).

scholarly journals Evaluation of the Symmetry of the Levator Veli Palatini Muscle and Velopharyngeal Closure Among a Noncleft Adult Population

2020 ◽  
pp. 105566562096126
Author(s):  
Neda Tahmasebifard ◽  
Charles Ellis ◽  
Kathrin Rothermich ◽  
Xiangming Fang ◽  
Jamie L. Perry
Keyword(s):  
Adult Population ◽  
Levator Muscle ◽  
Levator Veli Palatini ◽  
Visualization Software ◽  
Velopharyngeal Closure ◽  
Nonsignificant Difference ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Impact ◽  
Typical Range

Purpose: The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of the observed asymmetry on velopharyngeal closure. A second objective is to report normative length and thickness of the levator veli palatini muscle among adults with typical velopharyngeal anatomy. Method: Magnetic resonance imaging (MRI) data and Amira 5.5 Visualization software were used to evaluate the levator veli palatini muscle among 89 participants with typical velopharyngeal anatomy. Flexible nasopharyngoscopy was used to determine the function of velopharyngeal closure among 39 of the 89 participants with typical velopharyngeal anatomy to examine the functional impact of observed asymmetry. Results: Matched paired t tests demonstrated a nonsignificant difference between the length and thickness of the right and left levator muscle. The mean difference between the right and left length of the levator muscle was 2.28 mm but ranged from 0.09 mm to 10.37 mm. In all cases where individuals displayed asymmetry in the levator muscle through MRI, there was no observed impact on the symmetry of velopharyngeal closure. Discussion: This study suggest that differences in the right and left levator veli palatini muscle are not significant among individuals without cleft palate. However, among individual cases where asymmetry was sizeable, there was no direct impact on the closure pattern. This may suggest there are multiple factors that contribute to asymmetrical velopharyngeal closure that are beyond the level of the levator veli palatini muscle.

Levator Veli Palatini Muscle Fatigue during Phonation in Speakers with Cleft Palate with Borderline Velopharyngeal Incompetence

2006 ◽  
Vol 43 (1) ◽  
pp. 103-107 ◽  
Author(s):  
Kanji Nohara ◽  
Takashi Tachimura ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Regression Line ◽  
Power Spectral Analysis ◽  
Levator Muscle ◽  
Control Group ◽  
Mean Power ◽  
Mean Power Frequency ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Syllable Repetition

Objective This study examined whether the levator veli palatini muscle in speakers with borderline velopharyngeal incompetence (BVP) with surgically treated cleft palate might be more fatigable during speech than that in speakers without clefts. Design Each subject was asked to pronounce the syllable /pu/ more than 50 times at a rate of one time per second. Mean power frequency (MPF) of one syllable was obtained from electromyogram data of the levator muscle by power spectral analysis. Participants Five patients with postsurgical cleft palates, who were identified as having BVP by nasopharyngeal fiberscopy, served as subjects, and five participants without clefts served as the control group. Results In all participants without clefts, the slopes of the regression line relating MPF to the course of syllable repetition were negative but not significant. However, in all participants with BVP, the slopes of the regression line were significantly negative. Conclusions These findings demonstrated that the levator muscle of speakers with BVP was more fatigable than that of speakers without clefts during repetition of syllables. This study suggests that the fatigability of levator muscle contributed to mild hypernasality in patients with BVP.

Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation in Cleft Palate Subjects

1995 ◽  
Vol 32 (5) ◽  
pp. 376-381 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Cleft Palate ◽  
Air Pressure ◽  
Levator Muscle ◽  
Emg Activity ◽  
High Activation ◽  
Levator Veli Palatini ◽  
Activation Level ◽  
High Activation Level ◽  
Intraoral Air Pressure ◽  
Total Activation

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed In relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.

Nasalance Scores in Wearers of a Palatal Lift Prosthesis in Comparison with Normative Data for Japanese

2004 ◽  
Vol 41 (3) ◽  
pp. 315-319 ◽  
Author(s):  
Takashi Tachimura ◽  
Yasuko Kotani ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Normative Data ◽  
Normal Limits ◽  
Velopharyngeal Incompetence ◽  
The Mean ◽  
Velopharyngeal Function ◽  
Normative Score ◽  
Nasal Emission ◽  
Normal Controls

Objective This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality. Design Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed. Participants Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both. Main Outcome Measures Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP. Results Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported. Conclusion A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

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