OBJECTIVETo study the relationship between velopharyngeal morphology and velopharyngeal function in operated cleft palate patients with velopharyngeal competence (VPC) with levator veli palatini retropositioning according to Sommerlad.

METHODSThree groups were included in the study. The experimental group comprised 18 incomplete cleft patients (group T1) repaired with VPC repaired with levator veli palatini retropositioning according to Sommerlad and 14 incomplete cleft patients (group T2) with velopharyngeal incompetence (VPI) repaired with Langenbeck's technique. The control group was composed of 13 normal adults. The outcome of the velopharyngeal function by nasopharyngoscopy and lateral cephalogram was assessed. Skeletal landmarks and measurements were derived from the tracing of lateral cephalograms. The measurements included velar length, pharyngeal depth, and adequate ratio of velar length to pharyngeal depth. The cranial base, cervical vertebrae, posterior nasal spine, and the position of the posterior pharyngeal wall (PPW) in the pharyngeal triangle were also analyzed. All data were subjected to student's t-test of statistical significance.

RESULTSAll 18 subjects in group T1 obtained complete velopharyngeal closure. Velopharyngeal closure in seven, five, and two subjects in group T2 was 70%, 50% to 70%, and less than 50%, respectively, according to the results of nasopharyngoscopy. The lateral velar length (25.7 mm + 2.3 mm) in group T1 was similar to that of the control group (29.9 mm + 2.7 mm) (P > 0.05). The pharyngeal depth in group T1 was shorter than that in the other two groups, and the adequate ratio (1.43 + 0.26) was similar to that in the normal group (1.45 + 0.26). Group T2 had a significantly short velar length (22.9 mm + 2.3 mm) and normal pharyngeal depth, resulting in a small length/depth ratio (0.95 + 0.14) than that in group T1 and the control group. PPW in the pharyngeal triangle was positioned superiorly in group T2 compared with the control group.

CONCLUSIONThe velopharyngeal morphology of operated cleft palate patients with VPC with levator veli palatini retropositioning according to Sommerlad was found to be similar to that of the normal control group. VPI cleft palate patients are characterized by a shorter palate, smaller adequate ratio (< 1.0), slightly counterclockwise-rotated pharyngeal triangle, and superiorly positioned PPW.