Yoshiaki Sakamoto1, Shigeyoshi Soga2, Masahiro Jinzaki3, Yoshitake Yamada4, Hisao Ogata1, Kazuo Kishi1. 1. Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan. 2. Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. 3. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan. Electronic address: jinzaki@rad.med.keio.ac.jp. 4. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan.
Abstract
OBJECTIVE: Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palate patients based on dynamic volume scanning with 320-detector-row CT. METHODS: Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. RESULTS: 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. CONCLUSIONS: 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.
OBJECTIVE: Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palatepatients based on dynamic volume scanning with 320-detector-row CT. METHODS: Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. RESULTS: 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. CONCLUSIONS: 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.
Authors: Austin S Lam; Michael D Bindschadler; Kelly N Evans; Seth D Friedman; Matthew S Blessing; Randall Bly; Michael L Cunningham; Mark A Egbert; Russell E Ettinger; Emily R Gallagher; Richard A Hopper; Kaalan Johnson; Jonathan A Perkins; Erin K Romberg; Kathleen C Y Sie; Srinivas M Susarla; Carlton J Zdanski; Xing Wang; Jeffrey P Otjen; Francisco A Perez; John P Dahl Journal: Otolaryngol Head Neck Surg Date: 2021-07-13 Impact factor: 3.497