MRI Analyses of the Velopharyngeal Mechanism among Different Adult Populations

描述(由申请者提供)：很可能有特定维度的腭咽肌肉组织是儿童发展正常发音语言所必需的。如果儿童的提肌初次修复不符合正常解剖学，他们很可能会发展成上鼻音，并需要二次腭部手术。数据还没有证明什么是“正常”的提肌解剖结构，或者种族和性别如何影响这些标准测量。我们将阐明基于性别、种族、颅骨测量尺寸和/或腭咽闭合模式的标准肌肉尺寸范围是什么。这些结果可直接用于指导初次手术。这种针对患者的手术计划将减少语言发育过程中过度鼻音的发生率，从而减少以后二次手术治疗的需要。这项R03提案的目的是解决有关种族和性别对腭咽结构和功能的相互作用的悬而未决的问题。这项研究还将评估颅骨测量和腭咽闭合模式的相互作用，因为它与不同种族/民族和/或性别群体中发现的提肌尺寸有关。对这些变量之间关系的分析将使我们能够确定口腔裂隙的种族差异是否是骨骼肌水平上的形态差异的结果。更适用的是，这里获得的数据将对先天性腭裂儿童的手术实践产生直接影响。因此，这项研究的长期目标是改善对出生时患有腭裂的儿童的诊断和手术计划护理。从这些调查中收集的信息将导致语音结果测量的改善，以及后续二次腭部手术的需求减少。提出了以下具体目标：(A)确定静止和言语产生过程中提肌的形态差异；(B)确定静止或言语产生过程中提肌形态是否存在性别差异。共有84名受试者将被招募参与研究。当胎膜处于静止状态(非语音)和说话时，将获得磁共振图像。磁共振图像将用于测量颅骨测量和提肌形态。将进行鼻内窥镜检查以确定腭咽闭合模式。这些数据将被导入3D软件系统，以创建三维空间的计算机模型，以改进内部颅面和腭咽结构的测量和可视化。 公共卫生相关性：Hardin-Jones和Jones(2005)发现68%的修复了腭裂的学龄前儿童参加了语言治疗。更有趣的是，37%的人有中度到重度的上鼻音，或者由于腭咽闭合机制不健全而接受了二次手术治疗。根据患者的种族、性别和提肌大小(基于种族、性别和提肌大小)进行一次手术修复(初始手术)将减少许多腭裂儿童中发现的异常言语的发生率，并减少后续手术(二次手术治疗)的需要。

DESCRIPTION (provided by applicant): It is likely that there are specific dimensions for the musculature of the velopharynx that are required in order for a child to develop normal sounding speech. If a child has a primary repair of the levator muscle that does not conform to that of normal anatomy, it is likely that they will develop hypernasal speech and would require secondary palate surgery. Data has not demonstrated what constitutes "normal" levator muscle anatomy or how race and sex impact those normative measures. We will elucidate what constitutes normative muscle dimension range based on sex, race, craniometric dimensions, and/or velopharyngeal closure patterns. These results can be directly utilized to guide primary surgery. Such patient specific surgical planning will decrease the incidence of hypernasality during speech development and thus reduce the need for secondary surgical management later in life. The aims of this R03 proposal are to address unresolved issues concerning the interaction of race and sex on the structure and function of the velopharynx. The study will also assess the interaction of craniometric measurements and velopharyngeal closure patterns as it relates to levator dimensions found in different racial/ethnic groups and/or gender groups. Analyses of the relationship of these variables will enable us to identify whether racial differences in oral clefts are a result of morphological differences at the skeleto- muscular level. More applicably, data obtained here will have a direct impact on surgical practices in the treatment of children born with cleft palate. Thus, the long term goal of this study is to improve the diagnostic and surgical planning care for children born with cleft palate. The information gathered from these investigations will lead to improved speech outcome measures as well as a reduced need for subsequent secondary palatal surgeries. The following specific aims are proposed: (a) to identify morphologic differences in the levator muscle at rest and during speech production as a function of race (b) to determine whether sex differences exist in the morphology of the levator muscle at rest or during speech production. A total of 84 subjects will be recruited for participation in the study. Magnetic resonance images will be obtained while the velum is at rest (non-speech) and during speech. MR images will be used to measure craniometric measures and levator muscle morphology. Nasoendoscoy will be performed to determine velopharyngeal closure patterns. The data will be imported into a 3D software system to create a computer model in three dimensions of space for improved measurements and visualization of the internal craniofacial and velopharyngeal structures. PUBLIC HEALTH RELEVANCE: Hardin-Jones and Jones (2005) found 68% of preschoolers with repaired cleft palate were enrolled in speech therapy. More interestingly, 37% had moderate to severe hypernasality or had received secondary surgical management due to an incompetent velopharyngeal mechanism. Primary surgical repair (initial surgery) that is patient specific (based on race, sex, and levator muscle dimensions) would reduce the incidence of aberrant speech found among many children with cleft palate and reduce the need for subsequent surgeries (secondary surgical management).