Using MRI to Facilitate Precision Medicine for Infants with Cleft Palate - PROJECT SUMMARY Orofacial clefting is the most common birth defect in the United States and the leading cause of velopharyngeal insufficiency, the inability to close the velopharynx by separating the oral and nasal cavities while speaking. Adequate velopharyngeal closure is essential for intelligible speech production; it has been suggested that children with repaired cleft palate acquire velopharyngeal closure and oral stop consonants later than typically developing peers, and thus are not able to produce intelligible speech during a critical time in speech and language development. Despite typical surgical reconstruction of the palate by 12 months of age, an estimated 84% of children with cleft palate will require speech therapy and nearly 40% will need additional surgical management to facilitate adequate velopharyngeal closure. Although literature has demonstrated that specific anatomical variables consistently result in velopharyngeal insufficiency, variability and genuine uncertainty exist regarding early treatment decisions for this population, resulting in umbrella protocols for surgical timing and speech monitoring. The proposed research aims to address this need by identifying which pre-operative dimensions are predictive of surgical selection in infants with cleft palate and by comparing post-surgical anatomical dimensions with speech production skills. The proposed study will enroll 30 infants prior to their palate repair at 10 months and follow them until 16 months of age. Non-sedated magnetic resonance imaging of the velopharynx will be completed at both time points (pre- and post-palate repair), and a home-based speech recording will accompany the 16-month scan. Additional demographic, hearing, development, and speech and language data will be obtained at both timepoints to help explain any variability not accounted for by age or surgical type. Specific Aim I will establish which pre-surgical anatomical features are predictive of surgical procedure selection based on perceptual assessment of intraoperative tension for palate repair. We hypothesize that pre-operative cleft width and levator veli palatini muscle length are predictive of surgical procedure selection based on intraoperative tension of palatal tissue. Specific Aim II will determine which post-surgical anatomical features are associated with the greatest diversity in oral stop consonant production at 16 months in children with repaired cleft palate. We hypothesize that a longer velum, greater effective velopharyngeal ratio, and continuity of the levator veli palatini muscle are associated with greater diversity of oral stop consonants by 16 months, but not with surgical procedure type. The proposed research will provide information that has the potential to shift the current clinical paradigm, allowing for informed surgical selection based on patient-specific anatomy and early identification of velopharyngeal insufficiency within a critical window for typical speech development. In addition, this research has important implications for improving our theoretical understanding of anatomical and physiological factors that directly contribute to surgical success within this population and could be leveraged to individualize treatment techniques and optimize speech outcomes for children with cleft palate.
