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PubMed1985

The bifid uvula: is it a marker for an otitis prone child?

All children seen by a pediatrician in a suburban practice during an 18-month interval were examined carefully for the presence of an abnormal uvula. Isolated bifid uvula, without overt cleft palate, was detected among 44 children who had been followed in the practice during the first three years of life. A chart review was performed to determine the frequency of acute otitis media (AOM) and of insertion of tympanostomy tubes among these study patients and among age-matched controls with normal uvulas. Compared to control children, a slightly higher proportion of children with bifid uvulas had experienced more than one episode of AOM (64% vs. 49%) and more than three episodes of AOM (16% vs. 8%) during the first year of life, but these differences were not statistically significant. By age 3 years, the incidences of AOM in the compared groups were more nearly equal. Insertion of tympanostomy tubes during the first three years of life for persistent middle ear effusion was slightly more common among the bifid uvula group than among the controls (14% vs. 10%), but this difference again was not statistically significant. Children with bifid uvula may be at slightly increased risk of middle ear problems during the first years of life, but the magnitude of this increase, if any, appears small.

Age Factors↗
PubMed1994

Stimulation of the nodulus and uvula discharges velocity storage in the vestibulo-ocular reflex.

The nodulus and sublobule d of the uvula of rhesus and cynomolgus monkeys were electrically stimulated with short trains of pulses to study changes in horizontal slow-phase eye velocity. Nodulus and uvula stimulation produced a rapid decline in horizontal slow phase velocity, one aspect of the spatial reorientation of the axis of eye rotation that occurs when the head is tilted with regard to gravity during per- and post-rotatory nystagmus and optokinetic after-nystagmus (OKAN). Nodulus and uvula stimulation also reproduced the reduction of the horizontal time constant of post-rotatory nystagmus and OKAN that occurs during visual suppression. The brief electric stimuli (4-5 s) induced little slow-phase velocity and had no effect on the initial jump in eye velocity at the onset or the end of angular rotation. Effects of stimulation were unilateral, suggesting specificity of the output pathways. Activation of more caudal sites in the uvula produced nystagmus with a rapid rise in eye velocity, but the effects did not outlast the stimulus and did not affect VOR or OKAN time constants. Thus, stimulation of caudal parts of the uvula did not affect eye velocity produced by velocity storage. We postulate that the nodulus and sublobule d of the uvula control the time constant of the yaw axis (horizontal) component of slow-phase eye velocity produced by velocity storage.

Animals↗
PubMed1985

Zonal organization of olivocerebellar projections to the uvula in rabbits.

Olivocerebellar projections to the uvula were studied by means of retrograde axonal transport of horseradish peroxidase (HRP) in pigmented rabbits. The distribution pattern of labeled cells in the inferior olive was compared among cases following large- and microinjections of HRP into the uvula. Findings indicate topographically organized projections to longitudinally oriented zones. There are at least 6 zones in the rabbit's uvula. The caudal part of the nucleus beta projects contralaterally to a most medially located zone (caudal beta zone). The rostral part of the nucleus beta projects to a little more laterally located zone (rostral beta zone) at a distance of about 1 mm from the midline of the uvula. The caudolateral part of the MAO projects to a zone (caudolateral MAO zone) located laterally to the rostral beta zone. The dorsomedial cell column projects to a zone (dorsomedial cell column zone) located in the intermediate part of the uvula at about 2 mm from the midline. The rostrolateral part of the MAO projects to the most lateral zone (rostrolateral MAO zone) of the uvula. Finally, the ventral lamella of the PO projects to a zone (ventral lamella of PO zone) located between the rostrolateral MAO zone and the dorsomedial cell column zone.

Animals↗
PubMed1987

Topographical distribution of Purkinje cells in the uvula and the nodulus projecting to the vestibular nuclei in cats.

The localization of the Purkinje cells in the uvula and nodulus projecting to the vestibular nuclei and the prepositus hypoglossal nucleus (PH) was studied by means of retrograde axonal transport of horseradish peroxidase in cats. Findings indicate a zonal organization in the uvula and nodulus projecting to the vestibular nuclei as follows; the Purkinje cells located in the medial half of the uvula except for the area along the posterolateral fissure project to the middle part of the inferior vestibular nucleus (IV) (middle IV zone); those in the lateral half of the uvula other than the laterocaudal part project to the caudal part of the IV (caudal IV zone); those in the mediorostral part of the nodulus and the middle part of the nodulus project to the middle part of the medial vestibular nucleus (MV) (middle MV zone); those in the lateral part of the nodulus project to the caudal part of the MV (caudal MV zone); those in the medial part of the uvula and nodulus along the posterolateral fissure project to the dorsal peripheral part of the superior vestibular nucleus (SV) (SV zone). There is no specific projection zone in the uvula and nodulus projecting to the lateral vestibular nucleus, the ventral peripheral and the central part of the SV, the rostral part of the MV, the rostral part and the caudal pole of the IV, the caudal one-third of the group f, the group x and the PH.

Animals↗
PubMed1995

Projection of cardiovascular afferents to the lateral nodulus-uvula of the cerebellum in rabbits.

Vagal and aortic afferent projections to the nodulus and uvula of the cerebellar vermis were examined in anesthetized and paralysed rabbits. Electrical stimulations of vagal and aortic nerves at a frequency of 1/s produced field potentials in the lateral cortical region of the contralateral nodulus-uvula with a latency of 6.5-19 ms. These potentials were negative in the molecular layer and positive in the granular layer. At a higher stimulation rate (30/s), these potentials were reduced by 60-65% of the control value. These results indicate that the lateral cortical region of the nodulus-uvula receives contralateral vagal and aortic afferent signals via climbing fibers. Electrical stimulation of vagal nerves also produced field potentials in the lateral region of the ipsilateral nodulus-uvula with a latency of 6-10.5 ms. Their laminal profile was characteristic of mossy fiber responses. At a higher stimulation rate (30/s), the reduction of these potentials was only 35%. Thus the lateral nodulus-uvula also receives the ipsilateral vagal afferent signals via mossy fibers. Following injection of horseradish peroxidase into the small areas of the lateral nodulus, labeled cells were found in bilateral intercalatus nucleus, prepositus hypogrossal nucleus, Roller nucleus, medial fascicullus longitudinalis, and medial and lateral vestibular nuclei. These nuclei may contain precerebellar neurons in the pathway from the vagal nerve to the lateral nodulus-uvula via mossy fibers.

Animals↗
PubMed1978

The pontocerebellar projection of the uvula in the cat.

The occurrence of retrogradely labeled cells in the pontine nuclei was mapped following injections of 0.3-0.4 microliter of a horseradish peroxidase suspension (50% weight/volume) into the uvula (lob. IX of Larsell) in the cat. The uvula was found to receive afferents from three pontine cell collections. One of these is situated in the paramedian pontine nucleus close to the midline. It forms a fairly distinctly outlined longitudinal column of cells and is present at all levels of the pons except most rostrally and caudally. Another group, in the dorsolateral and lateral pontine nuclei, extends as a somewhat shorter cell column in the longitudinal direction. The third region consists of cells within the rostral part of the peduncular nucleus in its dorsomedial region. The pontine projection to the uvula is bilateral, with some preponderance of crossed connections. The projection to the uvula is organized according to the pattern determined previously for pontine projections to other parts of the cerebellum. A single lobule or part of its receives afferents from more than one cell group in the pons. The projecting cells are most often arranged in longitudinal columns. Correlations with data on the termination of afferents to the pons permit some conclusions regarding the sources of information reaching the uvula via the pons. Main sources seem to be the superior and inferior colliculi, the intracerebellar nuclei and the sensorimotor cortices.

Afferent Pathways↗
PubMed1983

The olivocerebellar projection to the uvula in the mouse.

The organization of the olivocerebellar projection in the mouse was studied with the use of microinjections of horseradish peroxidase (HRP) or HRP conjugated to wheat germ agglutinin (WGA-HRP). Injections were made in medial, intermediate, and lateral sites along the width of the uvula. The purpose of this investigation was to determine the subnuclear origin of olivary afferents to different mediolateral regions of the uvula. Injections made in or adjacent to the midline of the uvula resulted in the retrograde labeling of cells, bilaterally in the caudal portion of the medial accessory olive (MAO). These labeled cells were located primarily in subnucleus C and nucleus beta of the MAO. Injections into the intermediate part of the uvula resulted in the labeling of cells in the caudal MAO (primarily nucleus beta), the dorsomedial cell column (dmcc), and a few cells in the ventral lamella of the principal olive (vPO). Laterally placed injections produced labeling of cells in dmcc and the vPO. These results are discussed in reference to the parasagittal organization of olivary afferents to the cerebellar cortex in the mouse (Beyerl et al., '82) and the organization of afferents to the involved regions of the inferior olivary (IO) complex. It is suggested that these parasagittal zones in the uvula may play different roles in the control of eye movements.

Animals↗
PubMed2003

Partial segregation of posterior crista and saccular fibers to the nodulus and uvula of the cerebellum in mice, and its development.

The projection of the posterior canal crista and saccular afferents to the cerebellum of embryonic and neonatal mice was investigated using carbocyanine dyes. Anterograde tracing from these two endorgans reveals a partial segregation of these two sets of afferents. The saccule projects predominantly to the uvula, with very minor input to the nodulus. The posterior canal projects mainly to the nodulus and, to a lesser extent, to the uvula. Retrograde tracing from the uvula and nodulus confirms this partial segregation for these two endorgans and extends it to other vestibular endorgans. Uvular injections result in many more labeled fibers in the gravistatic maculae than in the canals' cristae. In contrast, nodular injection reveals many more labeled fibers in the canal cristae than in the gravistatic maculae. This partial segregation may play a role in the information processing in these folia. Our developmental data suggest that the initial segregation at E17 coincides with the formation of the postero-lateral fissure. This embryonic segregation of the primary vestibular mossy fibers to the uvula and nodulus commences long before the maturity of their targets, the granule cells and unipolar brush cells. Thus, the segregation of the primary vestibular projection to the uvula and nodulus does not depend on cues related to the target cells. Rather, the segregation may reflect more global cerebellar patterning mechanisms involving guidance for the vestibular afferent fibers independent of the future target cells.

Aging↗
PubMed2000

Direct projection from the cardiovascular control region of the cerebellar cortex, the lateral nodulus-uvula, to the brainstem in rabbits.

In decerebrate unanesthetized rabbits, electrical stimulation of the lateral nodulus-uvula in the cerebellar vermal cortex evoked an increase in renal sympathetic nerve activity, an increase in blood pressure and a decrease in renal arterial blood flow, which were all in contrast to the effects reported previously in the anesthetized rabbits. In order to identify the pathway mediating these responses, we investigated the Purkinje cell projection from the lateral nodulus-uvula using both anterograde (biotinylated dextran amine, BDA) and retrograde (horseradish peroxidase, HRP) tracing methods in rabbits. When BDA was iontophoretically injected into the lateral nodulus-uvula, labeled Purkinje cell axons were found within and around the superior and inferior cerebellar peduncles (SCP and ICP, respectively). Furthermore, terminal-like fields were found in the dentate and vestibular nuclei as reported in previous studies. However, the terminal-like patterns that we observed in the parabrachial nucleus (PB) in the rabbit have not been reported yet. When HRP was microinjected into the lateral PB, retrogradely labeled Purkinje cells were found in the lateral nodulus-uvula. These results indicate that Purkinje cells in the lateral nodulus-uvula project into the vestibular nuclei via the ICP and to the lateral PB via the SCP. We suggest that these two pathways mediating cardiovascular responses have different sensitivities to anesthetics.

Animals↗
PubMed1995

Vestibular and visual climbing fiber signals evoked in the uvula-nodulus of the rabbit cerebellum by natural stimulation.

1. The cerebellar uvula-nodulus receives vestibular projections from primary and secondary vestibular afferents as well as vestibularly related climbing fibers. It also receives visually related information from climbing fiber pathways. In this experiment we investigated how this information is mapped onto the uvula-nodulus. We studied the specificity, dynamics, and topographic distribution of climbing fiber responses (CFRs), simple spike responses, and mossy fiber terminal responses evoked by vestibular and optokinetic stimulation in rabbits anesthetized with alpha-chloralose. 2. Vestibularly evoked CFRs were found in the ventral uvula and nodulus. These responses were evoked during static roll tilt of the rabbit about a longitudinal axis and by sinusoidal oscillation about the longitudinal axis. Purely static responses were attributed to stimulation of the utricular otolith by the linear acceleration of gravity. CFRs that lacked a static component were attributed to activation of the semicircular canals. 3. Using a "null technique" we showed that the canal-sensitive CFRs were caused by stimulation of the anterior or posterior semicircular canals. Of the CFRs classified as canal related, 96% could be attributed to stimulation of the vertical semicircular canals. 4. Increases in CFRs were correlated with decreases in simple spike responses in half the Purkinje cells from which we recorded. These climbing-fiber-induced pauses in simple spikes occurred during spontaneous climbing fiber discharge as well as during climbing fiber discharge evoked by vestibular stimulation. The duration of this pause was inversely proportional to the spontaneous level of simple spikes before the occurrence of a CFR. In the other half of the recorded population of Purkinje cells, vestibularly driven CFRs did not alter the simple spike responses. 5. Vestibularly and visually mediated CFRs were topographically represented on the surface of the uvula-nodulus. CFRs driven by ipsilateral otolithic inputs were distributed over the entire mediolateral surface of the uvula-nodulus. CFRs driven by the ipsilateral posterior semicircular canal were distributed in a sagittal strip approximately 1.5 mm wide, extending laterally from the midline of the nodulus. CFRs driven exclusively by horizontal, posterior-->anterior optokinetic stimulation of the ipsilateral eye were distributed in a sagittal strip approximately 0.5 mm wide located 0.5-1.0 mm from the midline and restricted to the ventral nodulus. CFRs driven by the ipsilateral anterior semicircular canal were found in a sagittal strip approximately 1.0 mm wide extending 1.0-2.0 mm from the midline. 6. The sagittal, topographically arrayed climbing fiber strips effectively map a mediolateral gradient of possible postural responses based on vestibular and optokinetic information.

Adaptation, Physiological↗
PubMed1998

Control of spatial orientation of the angular vestibuloocular reflex by the nodulus and uvula.

Spatial orientation of the angular vestibuloocular reflex (aVOR) was studied in rhesus monkeys after complete and partial ablation of the nodulus and ventral uvula. Horizontal, vertical, and torsional components of slow phases of nystagmus were analyzed to determine the axes of eye rotation, the time constants (Tcs) of velocity storage, and its orientation vectors. The gravito-inertial acceleration vector (GIA) was tilted relative to the head during optokinetic afternystagmus (OKAN), centrifugation, and reorientation of the head during postrotatory nystagmus. When the GIA was tilted relative to the head in normal animals, horizontal Tcs decreased, vertical and/or roll time constants (Tc(vert/roll)) lengthened according to the orientation of the GIA, and vertical and/or roll eye velocity components appeared (cross-coupling). This shifted the axis of eye rotation toward alignment with the tilted GIA. Horizontal and vertical/roll Tcs varied inversely, with T(chor) being longest and T(cvert/roll) shortest when monkeys were upright, and the reverse when stimuli were around the vertical or roll axes. Vertical or roll Tcs were longest when the axes of eye rotation were aligned with the spatial vertical, respectively. After complete nodulo-uvulectomy, T(chor) became longer, and periodic alternating nystagmus (PAN) developed in darkness. T(chor) could not be shortened in any of paradigms tested. In addition, yaw-to-vertical/roll cross-coupling was lost, and the axes of eye rotation remained fixed during nystagmus, regardless of the tilt of the GIA with respect to the head. After central portions of the nodulus and uvula were ablated, leaving lateral portions of the nodulus intact, yaw-to-vertical/roll cross-coupling and control of Tc(vert/roll) was lost or greatly reduced. However, control of Tchor was maintained, and T(chor) continued to vary as a function of the tilted GIA. Despite this, the eye velocity vector remained aligned with the head during yaw axis stimulation after partial nodulo-uvulectomy, regardless of GIA orientation to the head. The data were related to a three-dimensional model of the aVOR, which simulated the experimental results. The model provides a basis for understanding how the nodulus and uvula control processing within the vestibular nuclei responsible for spatial orientation of the aVOR. We conclude that the three-dimensional dynamics of the velocity storage system are determined in the nodulus and ventral uvula. We propose that the horizontal and vertical/roll Tcs are separately controlled in the nodulus and uvula with the dynamic characteristics of vertical/roll components modulated in central portions and the horizontal components laterally, presumably in a semicircular canal-based coordinate frame.

Animals↗
PubMed1984

Organization of the olivocerebellar projection to the uvula in the rat.

The present study was undertaken in order to determine the subnuclear origin of olivary parasagittal zones in the uvula of the rat cerebellum. Microinjections of horseradish peroxidase were made in different sublobules of the uvula ( sublobules IXa, b, and c of Larsell , 1952) and in different mediolateral positions within these sublobules . The results suggest that different specific regions of the contralateral inferior olive project to each of the parasagittal zones found within the uvula. Injections in the region of the most medial parasagittal zone result in the retrograde labeling of cells in 'subnucleus c' and nucleus beta subdivisions of the medial accessory olive (MAO). Injections in the intermediate region of the uvula result in the labeling of cells in the dorsomedial cell column. Finally, injections in the lateral part of the uvula result in the labeling of cells in the ventral lamella of the principal olive ( vPO ) or the rostral part of the MAO or both. There is some suggestion that the more rostral sublobules receive their input from the rostral MAO while the more caudal sublobule receives its input primarily from the vPO . These results agree fairly well with similar analyses of this projection system in the cat by Brodal in 1976.

Afferent Pathways↗
PubMedDate not supplied

Carcinoma of the uvula and midline soft palate: indication for neck treatment.

According to common classification and staging systems, tumors of the uvula and soft palate are included in the group of oropharyngeal cancers. As such, the same staging systems apply and therapeutic decisions are made accordingly. Our experience with small tumors of the uvula and midline soft palate has shown that these common rules may not apply in these anatomical sites. A multicenter retrospective study was performed to examine the aspects of presentation and clinical course of tumors of the uvula. Only patients with small tumors, less than 2.0 cm in diameter, were included. Twenty-three cases were reviewed. Eleven (47.8%) patients had clinical or radiologic evidence of neck disease on presentation. Five of 12 (41.7%) patients who presented with negative neck were found eventually to have neck disease. Eight patients had cervical recurrence. Only one patient had local recurrence. We suggest that attention may need to be directed to the treatment of the neck of all tumors of the uvula and midline soft palate, regardless of size.

Adult↗
PubMed2000

Morphometric analysis of the uvula in patients with sleep-related breathing disorders.

The upper-airway mucosa in obstructive sleep apnea (OSA) patients and snorers is often described as edematous and hyperplastic. The morphologic aspects of the pharyngeal mucosa, and in particular the mucosa of the uvula and soft palate, in OSA patients are, however, not well described. The aim of the present retrospective study therefore was to perform histologic examination of the pharyngeal mucosa obtained from patients with various forms of sleep-related breathing disorders, including primary snoring. A midsagittal section of uvulas obtained by uvulopalatopharyngoplasty (UPPP) was investigated in 34 OSA patients and 9 non-apneic snorers. Control tissues were taken by autopsy in 19 patients not known to have OSA or snoring. A morphometric point counting technique was used to determine the tissue composition. The data showed that OSA patients and non-apneic snorers had a significantly greater percentage of intercellular space than controls (65.7% vs 54.0%; P = 0.006). Control uvulas contained more muscle than OSA and snorers (14.0% vs 7.8%; P = 0.006). Moreover, the covering epithelium was significantly thicker in OSA and snorers than in controls (variance ratio = 7.64; P = 0.008). When taking body mass index (BMI) into account, no correlation was found between fat deposition and BMI. Findings showed that an increased clinical severity of OSA did not affect the tissue composition. Indeed, uvula morphology was similar in OSA patients with respect to non-apneic snorers. Since the increased amount of intercellular space is the expression of edema, we hypothesize that these mucosal changes together with hyperplasia of the covering epithelium are secondary effects to snoring. They presumably play a minor role in the etiopathogenesis of OSA, but may increase the severity of OSA by further narrowing the pharyngeal lumen.

Female↗
PubMed1992

Apnea and the elongated uvula.

Four cases of respiratory distress and apnea associated with an elongated uvula are presented. In all cases, the uvula was found to intermittently fall onto the epiglottis and vocal cords. In all four patients, resection of the uvula led to resolution of all airway symptoms. It is hypothesized that the uvula, touching the vocal cords, caused intermittent laryngospasm and subsequent symptoms of cough, airway obstruction, and cyanosis. The anatomic reasons for such phenomenon are discussed.

Airway Obstruction↗
PubMed1989

Bifid uvula: prevalence and association in otitis media with effusion in children admitted for routine otolaryngological operations.

Over a six month period, 709 children admitted for routine ENT operations were surveyed with regard to the presence of a bifid uvula as seen whilst under a general anaesthetic. The prevalence was found to be 7.5 per cent (53:709) which is higher than other published figures for a Caucasian population. There was a statistically significant male predominance (2.5:1). Comparison between those children found to have otitis media with effusion at operation and those having dry myringotomies, or operations not including myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis that bifid uvula as a microform of cleft palate is associated with an increased incidence of otitis media with effusion.

Adenoidectomy↗
PubMed1996

Inflammation in the uvula mucosa of patients with obstructive sleep apnea.

This study was conducted to determine whether inflammation is present in the uvula mucosa of patients with obstructive sleep apnea (OSA). Uvulas were obtained by uvulopalatopharyngoplasty in 21 patients with moderate OSA (mean apnea/hypopnea index and standard error of the mean: 32 +/- 4) and by autopsy in 5 individuals not known to have OSA. Using point counting in five randomly selected high-power microscopic fields (X100), the authors found that the number of leukocytes in the lamina propria of the uvula mucosa was significantly higher in patients with OSA than in the controls (179 +/- 12 cells vs. 71 +/- 4 cells, respectively; P < .05). This was due to a significant increase in the number of plasma cells in patients with OSA as compared with controls (89 +/- 15 cells vs. 21 +/- 5 cells, respectively; P < .05). The thickness of the lamina propria (an index of interstitial edema) was also significantly increased in patients with OSA compared with controls (0.99 +/- 0.12 mm vs. 0.27 +/- 0.02 mm, respectively; P < 0.05). The authors conclude that inflammation, characterized by plasma cell infiltration and interstitial edema, is present in the uvula mucosa of patients with moderate OSA. They also suggest that soft palate inflammation contributes to upper airway occlusion observed during sleep in these patients.

Adult↗
PubMed2002

Histopathology of the uvula and the soft palate in patients with mild, moderate, and severe obstructive sleep apnea.

OBJECTIVE: To study morphometric and qualitative histopathologic changes of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea. STUDY DESIGN: A prospective, nonrandomized controlled study. METHODS: The distal soft palate and uvula were excised during uvulopalatopharyngoplasty from 34 male patients with obstructive sleep apnea. Control specimens were retrieved from 7 male cadavers with no related disorders. All specimens underwent routine processing and the mid-sagittal sections were studied. Morphometric analysis of the relative proportions of the tissue constituents was carried out. Also, a qualitative assessment was performed to detect possible pathologic changes. RESULTS: The body mass index of patients was significantly higher from that of control subjects. The area fraction occupied by the tissue constituents of the distal portion of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea and in control subjects was similar, with small and insignificant differences regarding the contents of glands, muscle, fat, blood vessels, and the epithelium. Only the connective tissue was significantly greater in patients with moderate obstructive sleep apnea than in those with severe obstructive sleep apnea and control subjects. The qualitative assessment of the specimens disclosed normal tissue architecture without evidence of destruction. Vascular engorgement, fibrosis, edema, inflammatory cell infiltration, and dilated glandular ducts were observed in a portion of patients and control subjects. CONCLUSIONS: The structure of the distal soft palate and uvula of patients with obstructive sleep apnea undergoes insignificant changes and is independent of the body mass index levels, indicating that the pathologic changes are probably the sequela of airway obstruction rather than its cause.

Adult↗