Unilateral absence of levator veli palatini muscle: an extraordinary presentation in cleft palate

Abstract

Levator veli palatini (LVP) is the “key” muscle for velar elevation and speech. All cleft palate repair procedures emphasize on the correction of abnormally positioned levator palatini muscle. We encountered a case of unilateral absence of LVP muscle while operating for cleft palate in a non-syndromic 12-year-old male child. The velar space was in turn occupied by dense connective tissue. We also noticed a hypoplastic tendon of the tensor veli palatine (TVP) on the same side. Palatal repair was done in layers but the LVP “sling” could not be reconstructed. The 2-month-postoperative magnetic resonance imaging scan revealed absence of the velar portion of the LVP muscle and hypoplasia of extravelar portion of LVP and TVP muscles on the same side. Speech evaluation and fiberoptic nasopharyngoscopy performed after 3 months of palatoplasty verified the presence of velopharyngeal insufficiency (VPI). Superiorly based pharyngeal flap pharyngoplasty was performed to correct VPI. Presently, the child is on speech therapy and the results are encouraging. A thorough search on PubMed and Google on the unilateral absence of LVP muscle in an incomplete cleft palate did not show any similar case report or reference. A somewhat similar and rare clinical condition is unilateral velopharyngeal hypoplasia or hemipalatal hypoplasia.

Level of Evidence: Level V, diagnostic study