Impact of Muscular Asymmetry on Velopharyngeal Function in Children with Craniofacial Microsomia: A Pilot Study

ObjectiveTo quantify the morphology and asymmetry of the levator veli palatini (LVP) muscle in children with craniofacial microsomia (CFM) and explore associations with velopharyngeal insufficiency (VPI).DesignRetrospective cohort study.SettingPediatric tertiary care center.Patients, ParticipantsTwenty children with CFM who underwent clinically indicated head and neck MRI.Main Outcome MeasuresLVP left-right asymmetry, midline velopharyngeal measures, and presence of VPI.ResultsThree participants (15%) had VPI. Significant left-right asymmetry was observed for total LVP length, LVP thickness at velar insertion, and angle of origin (p ≤ .05). Greater differences between most and least affected sides in total LVP length were associated with lower VPI prevalence (PR, 0.58 per 1-mm increase; 95% CI, 0.36-0.93; p = .02). Greater pharyngeal depth predicted higher VPI prevalence (PR, 1.35 per 1-mm increase; 95% CI, 1.07-1.70; p = .01), while increased midline LVP thickness was associated with lower prevalence (PR, 0.76 per 1-mm increase; 95% CI, 0.65-0.90; p = .01).ConclusionChildren with CFM demonstrate significant asymmetry of the LVP muscle. Shorter total LVP length, thinner midline LVP, and greater pharyngeal depth were associated with higher VPI prevalence, indicating a need for prospective studies to clarify the role of soft-tissue variation in velopharyngeal function.