To provide detailed descriptions of contraction-induced morphometric changes in the extravelar segments of the levator veli palatini (LVP) muscle using 3-dimensional (3-D) magnetic resonance imaging (MRI).
Design:
Three-dimensional MRI data were acquired at rest and during “silent /i/” from 4 singers. During silent /i/, participants voluntarily sustained velar elevation while breathing orally for the entire scan time. Focusing on the extravelar segments, LVP length, angle of the muscle origin, and cross-sectional area (CSA), measurements were obtained and compared between tasks.
Results:
Three of the 4 participants exhibited the expected patterns of change following concentric contraction of the LVP muscle. Consistent changes from the resting to the contracted state included reductions in LVP length by 13.5% and angle of the muscle origin by 9.8%, as well as increases in CSAs by 22.1%, on average.
Conclusions:
This study presented high-resolution data of the LVP muscle behavior with the first in vivo 3-D measurements of the contracted LVP muscle, which can be useful for the validation of computational models that aim at describing biomechanical properties of the LVP muscle in future research. The active behavior of the extravelar LVP muscle also provides some insight on optimal LVP muscle geometry to consider during cleft palate repair.
BaeYKuehnDPSuttonBP. Magnetic resonance imaging of velar muscle tissue distribution in healthy adults. Cleft Palate Craniofac J. 2016;53(1):38–46.
2.
BaeYKuehnDPSuttonBPConwayCAPerryJL. Three-dimensional magnetic resonance imaging of velopharyngeal structures. J Speech Lang Hear Res. 2011;54(6):1538–1545.
3.
Bell-BertiF. An electromyographic study of velopharyngeal function in speech. J Speech Hear Res. 1976;19(2):225–240.
4.
Bell-BertiF.Understanding velic motor control: studies of segmental context. In: HuffmanMKKrakowRA, eds. Phonetics and Phonology, Volume 5: Nasals, Nasalization, and the Velum. Academic Press; 1993:63–85.
5.
CuttingCBRosenbaumJRovatiL. The technique of muscle repair in the cleft soft palate. Oper Tech Plast Reconstr Surg. 1995;2(4):215–222.
6.
DurlakJA. How to select, calculate, and interpret effect sizes. J Pediatr Psychol. 2009;34(1):917–927.
7.
EttemaSLKuehnDP. A quantitative histologic study of the normal human adult soft palate. J Speech Hear Res. 1994;37(6):303–313.
8.
EttemaSLKuehnDPPerlmanALAlperinN. Magnetic resonance imaging of the levator veli palatini muscle during speech. Cleft Palate Craniofac J. 2002;39(2):130–144.
9.
FantiniMFussiFCrosettiESuccoG. Estill Voice Training and voice quality control in contemporary commercial singing: an exploratory study. Logoped Phoniatr Vocol. 2017;42(4):146–152.
10.
FukinoKTsutsumiMSanudoJOnoTAkitaK. Anatomical significance of the spatial distribution of the palatopharyngeus with regard to velopharyngeal closure. Cleft Palate Craniofac J. 2019;56(7):744–750.
GandCGauntAS. Muscle architecture in relation to function. J Biomech. 1991;24(suppl 4):53–65.
13.
HaSKuehnDPCohenMAlperinN. Magnetic resonance imaging of the levator veli palatini muscle in speakers with repaired cleft palate. Cleft Palate Craniofac J. 2007;44(3):494–505.
14.
HwangKKimDJHwangSH. Microscopic relation of palatopharyngeus with levator veli palatini and superior constrictor. J Craniofac Surg. 2009;20(5):1591–1593.
15.
InouyeJMPerryJLLinKYBlemkerSS. A computational model quantifies the effect of anatomical variability on velopharyngeal function. J Speech Lang Hear Res. 2015;58(1):1119–1133.
16.
JoujimaTOdaMSasaguriMHabuMKataokaSMiyamuraYWakasugi-SatoNMatsumoto-TakedaSTakahashiOKokuryoS, et al.Evaluation of velopharyngeal function using high-speed cine-magnetic resonance imaging based on T2-weighted sequences: a preliminary study. Int J Oral Maxillofac Surg. 2020;49(1):432–441.
17.
KentRD.Nonspeech oral movements and oral motor disorders: a narrative review. Am J Speech Lang Pathol. 2015;24(2):763–789.
18.
KentRDCarneyPJSevereidLR. Velar movement and timing: evaluation of model for binary control. J Speech Hear Res. 1974;17(3):470–488.
19.
KollaraLPerryJL. Effects of gravity on the velopharyngeal structures in children using upright magnetic resonance imaging. Cleft Palate Craniofac J. 2014;51(1):669–676.
20.
KollaraLBaylisALKirschnerREBatesDGSmithMFangXPerryJL. Velopharyngeal structural and muscle variations in children with 22q11.2 deletion syndrome: an unsedated MRI study. Cleft Palate Craniofac J. 2019;56(6):1139–1148.
21.
KotlarekKJPerryJLFangX. Morphology of the levator veli palatini muscle in adults with repaired cleft palate. J Craniofac Surg. 2017;28(3):833–837.
22.
KuehnDP. A cineradiographic investigation of velar movement variables in two normals. Cleft Palate J. 1976;13(2):88–103.
23.
KuehnDMoonJB. Levator veli palatini muscle activity in relation to intraoral air pressure variation. J Speech Hear Res. 1994;37(3):1260–1270.
24.
KuehnDPEttemaSLGoldwasserMSBarkmeierJC. Magnetic resonance imaging of the levator veli palatini muscle before and after primary palatoplasty. Cleft Palate Craniofac J. 2004;41(6):584–592.
25.
KuehnDPEttemaSLGoldwasserMSBarkmeierJCWachtelJM. Magnetic resonance imaging in the evaluation of occult submucous cleft palate. Cleft Palate Craniofac J. 2001;38(2):421–431.
26.
KuehnDPMollerKT. Speech and language issues in the cleft palate population: the state of the art. Cleft Palate Craniofac J. 2000;37(5):1–35.
27.
KuhnCK. Breast MR imaging at 3 T magnetic resonance imaging clinics of North America. 2007;15(3):315–320.
28.
LakensD. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4( article 863):863.
29.
LubkerJF. An electromyographic-cinefluorographic investigation of velar function during normal speech. Cleft Palate J. 1968;5(2):1–18.
30.
MasonKNPerryJLRiskiJEFangX. Age related changes between the level of velopharyngeal closure and the cervical spine. J Craniofac Surg. 2016;27(1):498–503.
31.
MathiesonL. Greene and Mathieson’s the Voice and Its Disorders. Wiley; 2013.
32.
MollKL. Velopharyngeal closure on vowels. J Speech Hear Res. 1962;5:30–37.
33.
MoonJBSmithAEFolkinsJWLemkeJHGartlanM. Coordination of velopharyngeal activity during positioning of the soft palate. Cleft Palate Craniofac J. 1994;31(4):45–55.
34.
MyungYAhnTKimBKJeongJHBaekRM. Clinical significance of the levator veli palatini muscle in velocardiofacial syndrome patients: implications in velopharyngeal incompetence and pharyngeal flap surgery. Cleft Palate Craniofac J. 2018;55(5):521–527.
35.
NaraghiAWhiteLM. Three-dimensional MRI of the musculoskeletal system. AJR Am J Roentgenol. 2012;199(3):W283–W293.
36.
ParkMAhnSHJeongJHBaekRM. Evaluation of the levator veli palatini muscle thickness in patients with velocardiofacial syndrome using magnetic resonance imaging. J Plast Reconstr Aesthet Surg. 2015;68(8):1100–1105.
37.
PellandCMFengXBorowitzKCMeyerCHBlemkerSS. A dynamic magnetic resonance imaging-based method to examine in vivo levator veli palatini muscle function during speech. J Speech Lang Hear Res. 2019;62(8):2713–2722.
38.
PerryJL. Variations in velopharyngeal structures between upright and supine positions using upright magnetic resonance imaging. Cleft Palate Craniofac J. 2011;48(2):123–133.
39.
PerryJLKuehnDP. Three-dimensional computer reconstruction of the levator veli palatini muscle in situ using magnetic resonance imaging. Cleft Palate Craniofac J. 2007;44(4):421–423.
40.
PerryJLKuehnDPSuttonBP. Morphology of the levator veli palatini muscle using magnetic resonance imaging. Cleft Palate Craniofac J. 2013;50(5):64–75.
41.
PerryJLKuehnDPSuttonBPGamageJK. Sexual dimorphism of the levator veli palatini muscle: an imaging study. Cleft Palate Craniofac J. 2014a;51(5):544–552.
42.
PerryJLSuttonBPKuehnDPGamageJK. Using MRI for assessing velopharyngeal structures and function. Cleft Palate Craniofac J. 2014b;51(4):476–485.
43.
PerryJLKuehnDPSuttonBPFangX. Velopharyngeal structural and functional assessment of speech in young children using dynamic magnetic resonance imaging. Cleft Palate Craniofac J. 2017;54:408–422.
44.
SeaverEJKuehnDP. A cineradiographic and electromyographic investigation of velar positioning in non-nasal speech. Cleft Palate J. 1980;17(3):216–226.
45.
SommerladBC. A technique for cleft palate repair. Plast Reconstr Surg. 2003;112(10):542–548.
46.
SumidaKYamashitaKKitamuraS. Gross anatomical study of the human palatopharyngeus muscle throughout its entire course from origin to insertion. Clin Anat. 2012;25(6):314–323.
47.
TianWLiYYinHZhaoSFLiSWangYShiB. Magnetic resonance imaging assessment of velopharyngeal motion in Chinese children after primary palatal repair. J Craniofac Surg. 2010a;21(1):578–587.
48.
TianWRedettRJ. New velopharyngeal measurements at rest and during speech: implications and applications. J Craniofac Surg. 2009;20(4):532–539.
49.
TianWYinHLiYZhaoSZhengQShiB. Magnetic resonance imaging assessment of velopharyngeal structures in Chinese children after primary palatal repair. J Craniofac Surg. 2010b;21(2):568–577.
50.
TianWYinHRedettRJShiBShiJZhangRZhengQ. Magnetic resonance imaging assessment of the velopharyngeal mechanism at rest and during speech in Chinese adults and children. J Speech Lang Hear Res. 2010c;53(6):1595–1615.
51.
WooASSkolnickGBSachanandaniNSGramesLM. Evaluation of two palate repair techniques for the surgical management of velopharyngeal insufficiency. Plast Reconstr Surg. 2014;134(4):588e–596e.
