MRI Analyses of the Velopharyngeal Mechanism among Different Adult Populations

描述（由申请人提供）：为了使儿童形成正常发音的语言，腭咽的肌肉组织可能有特定的尺寸。如果儿童提提肌的初级修复不符合正常的解剖结构，他们很可能会发展出鼻音过重的语言，需要进行二次上颚手术。数据并没有证明什么是“正常的”提肌解剖结构，也没有证明种族和性别如何影响这些规范的测量。我们将根据性别、种族、颅测量尺寸和/或腭咽闭合模式阐明构成规范肌肉尺寸范围的因素。这些结果可以直接用于指导初级手术。这种针对患者的手术计划将减少语言发育过程中鼻音过亢的发生率，从而减少以后生活中二次手术治疗的需要。本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未解决的问题。该研究还将评估颅测量与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肛肌尺寸有关。分析这些变量之间的关系将使我们能够确定唇裂的种族差异是否是骨骼-肌肉水平形态差异的结果。更适用的是，这里获得的数据将直接影响先天性腭裂儿童治疗的外科实践。因此，本研究的长期目标是提高先天性腭裂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改善语言结果测量以及减少后续二次腭手术的需要。提出了以下具体目标：(a)确定提提肌在休息和语言产生过程中的形态差异作为种族的函数；(b)确定提提肌在休息或语言产生过程中的形态是否存在性别差异。本次研究共招募84名受试者。磁共振图像将在静息状态（非言语状态）和言语状态下获得。MR图像将用于测量颅骨测量和提提肌形态。将进行鼻内镜检查以确定腭咽闭合模式。数据将导入三维软件系统，创建三维空间的计算机模型，以改进颅面和腭咽内部结构的测量和可视化。

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).