Abnormal soft palate movements in patients with microtia

Microtia is a congenital malformation of the auricle, ranging in severity. It can be isolated or associated with (craniofacial) anomalies. Most of these anomalies together are described as being part of the oculo-auriculo-vertebral spectrum (OAVS). Velar abnormalities have been described to occur in patients with OAVS; however, the incidence in patients with microtia without OAVS is largely unknown. The primary purpose of this study was to examine the prevalence of velar palsy in patients with isolated microtia and patients with microtia and signs of OAVS. The secondary purpose was to identify possible risk factors associated with the presence of velar palsy.

All patients with microtia presented to our department between January 2015 and March 2017 were retrospectively reviewed. Medical images, information of the palate, and demographic data were extracted from the patients' medical files.

Velar palsy was present in 18 out of 42 patients with isolated microtia (43%; no signs of OAVS) and in 33 out of 41 patients with microtia and signs of OAVS (80%). Patients with signs of OAVS were found to be independently associated with a higher prevalence of velar palsy (OR: 4.8; 95% CI: 1.7-13).

This study demonstrates a clear relationship between abnormal velar movement and microtia. We believe that isolated microtia should not be seen as a separate entity but as a part of OAVS. Abnormal velar movement can lead to velopharyngeal insufficiency (VPI), which can affect speech development in children. Physicians should examine the palate in all patients with microtia and not restrict to those with speech difficulties.