Evaluating Velopharyngeal Function During Phonation in Children Utilizing Static MRI

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PROJECT SUMMARY/ABSTRACT Magnetic resonance imaging (MRI) has gained popularity as an imaging modality for children with a history of cleft palate and/or velopharyngeal insufficiency (VPI) because it is currently the only instrumental assessment technique that allows for direct visualization of velopharyngeal muscles and structures. Because MRI allows for direct visualization of velopharyngeal anatomy, it can be very helpful in surgical planning for children with velopharyngeal insufficiency; however, there are no data describing typical structure size and movement patterns of the velopharynx during phonation using the protocol many cleft and craniofacial centers use for MRI. The protocol many craniofacial clinics use consists of sustained phonation of /i/ (shows maximal contraction of the velopharynx during production of a vowel) and /s/ (shows maximal contraction of the velopharynx during production of a consonant). The goal of this study is to establish preliminary data among non-cleft subjects for sustained phonation of /i/ and /s/, as visualized on MRI. There is a critical need for normative data during sustained phonation of /i/ and /s/, and these norms should include consideration of an individual's race. Racial considerations are imperative because race can significantly impact velopharyngeal structure size at rest, and size of structures at rest impacts physiology for speech. This study will provide preliminary normative data to define typical anatomy and physiology of the velopharynx during these sustained phonation tasks across three racial groups: Asian, Black, and White. Such data can be used for comparison to children with a history of cleft palate and/or velopharyngeal insufficiency, given this same MRI protocol is used by many craniofacial centers. These normative findings will help researchers and clinicians gain a better understanding of the differences between typical and atypical velopharyngeal function and how race can impact typical velopharyngeal function for speech. To establish preliminary normative data in children without a history of cleft palate or velopharyngeal insufficiency, the current study proposes two aims to 1) define normal velar function during sustained phonation of /i/ and /s/, 2) examine normal levator veli palatini muscle contraction during sustained phonation of /i/ and /s/. This is innovative, as it will provide preliminary normative sustained phonation data, controlling for race, which can be used for direct comparison to the anatomy of patients with VPI. We plan to recruit 42 children without a history of cleft palate or VPI, all aged five (common age for VPI surgery), to complete the clinical velopharyngeal MRI protocol, including sustained /i/ and /s/.