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PubMed1975

The occult submucous cleft palate.

We have studied 41 patients with classic submucous cleft and 32 cases with occult submucous cleft. Both groups have the same anatomic abnormality that leads to velar dysfunction-the insertion of the palate muscles onto the hard palate rather than onto the midline soft palate raphe. However, the occult submucous cleft palate does not have the classic triad of bifid uvula, hard palate bony notch, and furrow in the midline of the soft palate. Characteristic facial features, cephalmetric x-rays, and cine voice studies can help make a presumptive diagnosis of occult submucous cleft palate. Surgical management includes a diagnostic palate exploration to identify muscle configuration followed by levator muscle sling reconstruction, palate pushback, and pharyngeal flap. Excellent speech results are obtained except with patients having palate paresis.

Abnormalities, Multiple↗
PubMed1992

Effects of implanting ram and wether lambs with zeranol at birth and weaning on palatability and muscle collagen characteristics.

Thirty-five zeranol-implanted (I) and nonimplanted (NI) ram and wether lambs representing four treatments (implanted rams [IR], nonimplanted rams [NIR], implanted wethers [IW], and nonimplanted wethers [NIW]) were evaluated for meat palatability and muscle collagen characteristics. Rib (longissimus muscle, LM) chops from I lambs were juicier (P less than .05) than rib chops from NI lambs. Chops from IR lambs had more (P less than .05) detectable connective tissue and lower myofibrillar and overall tenderness scores than chops from NIR, IW, or NIW lambs. Warner-Bratzler shear (WBS) values tended to be higher (P = .06) for LM chops from rams than for those from wethers, but WBS values for Biceps femoris (BF) chops were similar (P greater than .05) for rams and wethers. Implanting did not affect (P greater than .05) WBS values. Rams had more (P less than .05) LM heat-labile (soluble, SC), nonheat-labile (insoluble, IC), and total collagen (TC) and a higher (P less than .05) percentage of SC (SC/TC) than did wethers. Soluble collagen, TC, and percentage of SC for the BF were higher (P less than .05) and IC tended (P = .09) to be higher in chops from rams than in those from wethers. Implanting did not affect (P greater than .05) collagen amount or solubility. Serum nonprotein hydroxyproline (NPHP) was higher (P less than .05) in rams than in wethers throughout the feeding period and tended (P = .05) to be higher at slaughter. Implanting did not affect (P greater than .05) serum NPHP.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor.

Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.

Adult↗
PubMed2001

[Palatal aponeurosis and the insertion of the tensor muscle of the soft palate. An anatomic study and clinical applications].

INTRODUCTION: Knowledge of the anatomy of soft palate muscles is of great interest in cleft palate surgery, in surgical correction of obstructive sleep apnea syndrome and in excision of maxillo-facial carcinomas. Some authors described the palatal aponeurosis as the expansion of the tendon of the two tensor veli palatini muscles, others stated that the palatal aponeurosis is a distinct anatomic entity. METHOD: Ten dissections of the soft palate have been performed to improve our knowledge of its anatomy. RESULTS: The palatal aponeurosis is a distinct anatomic entity continuous with the periosteum of the nasal cavity. The tendon of the tensor veli palatini terminated on the inferior side of the aponeurosis. One fifth of the tensor's tendinous fibers terminated on the posterior border of the palatine bone and the others are spreading on the anterior and inferior side of the palatal aponeurosis. DISCUSSION: In cleft palate patients, this aponeurosis is absent, the palatal muscles are attached to the posterior border of the palatine bones. So it seems to be logical to recommend a soft-palate "pushback" to create a new space between the posterior border of the palatine bones and the soft-palate muscles.

Cleft Palate↗
PubMed1996

Palatopharyngeus has respiratory activity and responds to negative pressure in sleep apnoeics.

The intrinsic tongue muscle, genioglossus, and soft palatal muscles, tensor palatini, levator palatini and palatoglossus, are known to exhibit phasic respiratory activity and to respond reflexly to negative pressure in man, which may be important in the maintenance of upper airway patency. We hypothesized that the palatopharyngeus muscle should also have respiratory activity and increased activity in response to negative upper airway pressure. We have, therefore, examined the palatopharyngeus and the antagonist muscle, levator palatini, in eight awake sleep apnoea patients, using bipolar electromyography during nose- or mouth-breathing in different postures, and with or without application of negative pressure. Overall, palatopharyngeus and levator palatini demonstrated phasic respiratory activity. Palatopharyngeus demonstrated increased activity in the supine compared to erect posture. Analysis by route of respiration showed palatopharyngeus to be more active in the supine posture when nose-breathing compared to mouth-breathing. Graded negative pressure application caused significant increases in palatopharyngeus and levator palatini activity when applied via the mouth. Nasal negative pressure application caused a nonsignificant trend to increasing palatopharyngeus activity with increasing negative pressure compared to a significant increase for levator palatini. We conclude that palatopharyngeus and levator palatini demonstrate respiratory activity and reflex activation in response to negative pressure. Palatopharyngeus may, therefore, have a role as an upper airway dilator. The differential response of palatopharyngeus to oral and nasal negative pressure application may be important in the pathogenesis of sleep apnoea.

Adult↗
PubMed1995

Effect of breathing, pressure and posture on palatoglossal and genioglossal tone.

1. Patency of the upper airway is critical to respiration. Although about half of patients with the sleep apnoea/hypopnoea syndrome obstruct their upper airway at the retropalatal level, the respiratory actions of the palatal muscles have been little studied. We have therefore tested the hypothesis that the nasopharyngeal dilator muscle palatoglossus is activated during inspiration and by negative pressure. 2. Using intramuscular wire electrodes inserted perorally, we have compared the response of palatoglossus and genioglossus to breathing, posture change and airway negative pressure in 10 normal awake subjects before and after topical anaesthesia. The results are expressed as a percentage of maximal electromyogram. Data were analysed by repeated-measures analysis of variance. 3. Inspiratory activity was exhibited by both genioglossus [inspiratory, 10% +/- 2% (SEM); expiratory, 6% +/- 1%, P = 0.001] and palatoglossus (inspiratory, 16% +/- 5%, expiratory, 10% +/- 3%, P = 0.016), but only genioglossus exhibited increased activity on lying (supine 10% +/- 2%, erect 6% +/- 1% maximum, P = 0.01). 4. One hundred milliseconds after negative pressure application, activity increased in both genioglossus (7% +/- 2% and 13% +/- 3% respectively, P = 0.02) and palatoglossus (8% +/- 2% and 23% +/- 6% respectively, P < 0.001). After lignocaine surface anaesthesia to the nose and pharynx both genioglossus and palatoglossus still increased their activity in response to negative upper airway pressure, the extent of the increase being decreased for palatoglossus (P = 0.02) but not for genioglossus. 5. Thus, palatoglossus has respiratory activity and is activated by negative upper airway pressure.

Adult↗
PubMed1979

Styloid, velar, and pharyngeal muscles in cleft palate. Anatomical findings in elderly cadaver with unrepaired cleft palate.

Dessection of the musculature of the palate, pharynx, and styloid process was carried out in a cadaver aged 78 years with an unrepaired complete cleft palate. A new muscle named "the accessory stylohyoid" was found to be attached to the styloid process and the lesser cornu of the hyoid bone bilaterally. Anatomical changes in other muscles especially the stylopharyngeus and palatopharyngeus are described. The functions of these muscles are discussed on the basis of the anatomical findings and previous observations of other investigators.

Aged↗
PubMed1995

Histomorphologic analysis of the soft palate musculature in prenatal cleft and noncleft A/Jax mice.

The two specific aims of this study were as follows: to evaluate the appropriateness of the A/Jax mouse model in the investigation of the key cellular stages in prenatal soft palate morphogenesis and myogenesis; and to describe structural differences in the histomorphology of the soft palate anatomy from cleft and noncleft mice prior to, during, and after palatogenesis. Cleft-induced and control groups of A/Jax mouse embryos from timed pregnancies were harvested sequentially on gestational days 15 to 19. Embryos were weighed and staged for external body morphology. The heads were removed and fixed for light microscopy, sectioned serially in the frontal plane at 10 microns and stained with hematoxylin-eosin to characterize and compare the soft palate musculature. All observations were made at the head depth of the trigeminal ganglion in both age- and stage-matched embryos. The following findings were made: (1) the A/Jax mouse is a suitable animal model for the study of soft palate myogenesis; (2) there were no discernible morphologic differences between the soft palate muscles in cleft and noncleft A/Jax mice when viewed under light microscopy; (3) the soft palate and related muscles were identifiable as muscle fields, in both the cleft and noncleft fetuses, as early as gestational day 15 and as specific muscles at gestational day 18; (4) in both the cleft and noncleft A/Jax fetuses, the soft palate muscles appeared in a sequential anatomic fashion (the palatine aponeurosis appeared first, next the tensor palatini, and then the levator palatini muscles); and (5) in the cleft palate fetuses, both pterygoid plates were angulated and displaced laterally.

Analysis of Variance↗
PubMed2006

Soft palate mucosal adhesion as a preparation for Furlow's double-opposing Z-palatoplasty.

BACKGROUND: Furlow's double-opposing Z-palatoplasty enables both soft palate lengthening and palatal muscle reorientation, and outstanding speech results have been reported. However, Z-plasty often results in horizontal stress and requires relaxing incisions in some cases. This article presents the authors' novel two-stage Furlow double-opposing Z-palatoplasty used in 13 cleft lip-cleft palate patients. METHODS: During cheiloplasty, partial soft palate adhesion was performed. Only mucosal tissue was approximated to prevent damage to the palatal muscle. The residual palatal cleft decreased gradually, and palatoplasty was scheduled at the age of 1 year. Adhesive soft palate tissue was incised and Furlow's double-opposing Z-palatoplasty was performed in the usual manner. RESULTS: Eleven patients underwent Furlow's palatoplasty without relaxing incisions, and in two patients relaxing incisions were required along the inside of the alveolus. Relaxing incisions around the maxillary tuberosities were not required in any of the 13 cases. Analysis of the palatal cast models was carried out on the adhesion group (n = 13) and the control group (n = 9). In both groups, the mean distance between the tuberosities increased, and cleft widths at the alveolus and the middle of the hard palate were decreased. Furthermore, cleft width at the junction of the hard and soft palates was decreased significantly in the adhesion group compared with the control group. CONCLUSIONS: As a preparation for Furlow's palatoplasty, soft palate adhesion induced a decrease of cleft width without interfering with the transverse growth of the posterior maxilla and enabled Z-plasty of an adequate size without relaxing incisions.

Cleft Lip↗
PubMed1986

Cleft palate repair by double opposing Z-plasty.

In an attempt to improve speech results following palate repair while allowing adequate maxillary growth, a palatoplasty using two opposing Z-plasties of the soft palate, one of the oral and one of the nasal layers, has been used in 22 infants. Eight patients had unilateral cleft lip and palate, eight had bilateral cleft lip and palate, and six had cleft palate. The Z-plasties facilitate effective dissection and redirection of the palatal muscles to produce an overlapping muscle sling and lengthen the velum without using tissue from the hard palate, which permits hard palate closure without pushback or lateral relaxing incisions. Of the 20 children old enough for speech evaluation, 18 have no velopharyngeal insufficiency. Two have very mild velopharyngeal insufficiency. None has required a pharyngeal flap.

Cleft Palate↗
PubMed1985

Prolonged intensive therapy after snake bite. A probable case of envenomation by the rough-scaled snake.

A case of snake-bite envenomation, probably by the rough-scaled snake (Tropidechis carinatus), in a 9-year-old boy is reported which we believe to represent the most severe and prolonged case yet of non-fatal snake-bite envenomation in a human. The initial clinical features included loss of consciousness within minutes of the bite, followed by a period of partial recovery. The child subsequently developed total body paralysis, acute renal failure, and gross rhabdomyolysis. Artificial ventilation was maintained for 10 weeks; muscle paralysis and paresis persisted for 18 weeks before neuromuscular function returned to normal. Recovery occurred in centripetal fashion, the respiratory muscles and the palatal muscles being the last to recover. Acute renal failure persisted for 18 days and was treated by peritoneal dialysis. Some beneficial effects were seen even when antivenom was given 90 hours after the bite, but gross rhabdomyolysis caused by this species is not prevented by the administration of antivenom after 60 hours. It is concluded that if life can be sustained for 10 weeks by artificial ventilation, normal intellectual and neuromuscular recovery is possible in such cases.

Acute Kidney Injury↗
PubMed1994

Patterns of abnormal myogenesis in human cleft palates.

To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n = 4) to age-matched (n = 3) and nonmatched (n = 1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator veli palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed "normal" at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.

Case-Control Studies↗
PubMed1983

Computed tomography of the nasopharynx and related spaces. Part I: Anatomy.

The normal computed tomographic anatomy of the nasopharynx and pterygopalatine and infratemporal fossae is analyzed. Particular attention is given to the distinction between deglutitional and masticatory muscles. The relations of the palatal muscles to the eustachian tube are described in detail. Those soft-tissue features that, when they deviate from normal, can provide early detection of nasopharyngeal lesions are emphasized.

Humans↗
PubMed1996

Mechanisms of oronasal airflow partitioning in dogs.

We examined the integrated (MTA) electromyographic activity (EMG) of the hyoepiglotticus (HE) muscle and the soft palate muscles (SPM) during CO2 administration in 6 anaesthetised prone, mouth open dogs. As ventilation increased nasal flow (VN) as a percentage of total flow (VT), i.e. VN/VT%, decreased. Breath-by-breath peak inspiratory and peak expiratory HE EMG activity was strongly and inversely correlated with VN/VT% (both r > 0.8, p < 0.001), whereas the correlation between SPM MTA EMG activity and VN/VT% was highly variable. Severing of the HE muscles halved the rate at which VN/VT% was reduced with respect to increasing ventilation while electrical stimulation of HE muscle contraction resulted in a fall in VN/VT% to near zero levels. Active control of epiglottic position appears to be an important mechanism controlling the patency of the epiglottic-soft palate seal and thus the oronasal partitioning of airflow in dogs.

Anesthesia, General↗
PubMed1996

Supraglottic airway pressure-flow relationships during oronasal airflow partitioning in dogs.

We studied pressure-flow relationships in the supraglottic airway of eight prone mouth-open anesthetized (intravenous chloralose or pentobarbital sodium) crossbred dogs (weight 15-26 kg) during increasing respiratory drive (CO2 administration; n = 4) and during graded-voltage electrical stimulation (SV; n = 4) of the soft palate muscles. During increased respiratory drive, inspiratory airflow occurred via both the nose (Vn) and mouth (Vm), with the ratio of Vn to Vm [%(Vn/Vm)] decreasing maximally from 16.0 +/- 7.0 (SD) to 2.4 +/- 1.6% (P < 0.05). Simultaneously, oral airway resistance at peak inspiratory flow decreased from 2.1 +/- 1.0 to 0.4 +/- 0.4 cmH2O (P < 0.05), whereas nasal airway resistance did not change (14.4 +/- 7.2 to 13.1 +/- 5.4 cmH2O; P = 0.29). Inspiratory pressure-flow plots of the oral airway were inversely curvilinear or more complex in nature. Nasal pathway plots, however, demonstrated a positive linear relationship in all animals (r = 0.87 +/- 0.11; all P < 0.001). During electrical stimulation of soft palate muscle contraction accompanied by graded constant-inspiratory airflows of 45-385 ml/s through an isolated upper airway, %(Vn/Vm) decreased from 69 +/- 50 to 10 +/- 13% at a SV of 84 +/- 3% of maximal SV (P < 0.001). At a SV of 85 +/- 1% of maximum, normalized oral airway resistance (expressed as percent baseline) fell to 5 +/- 3%, whereas normalized nasal resistance was 80 +/- 9% (both P < 0.03). Thus control of oronasal airflow partitioning in dogs appears mediated more by alterations in oral route geometry than by closure of the nasopharyngeal airway.

Air Pressure↗
PubMed1995

Opercular myoclonic-anarthric status epilepticus.

We report 3 cases of opercular myoclonic status epilepticus (OMASE), characterized by fluctuating cortical dysarthria without true aphasia associated with epileptic myoclonus involving bilaterally the glossopharyngeal musculature. In this syndrome, the inferior rolandic area of either one or the other hemisphere is involved by an epileptogenic lesion of various etiology. Ictally, clonic expression was consistent with epilepsia partialis continua (EPC) and bilaterally and symmetrically involved palatal muscles (cases 1-3), tongue (cases 2 and 3), lips and chin (case 3), and inferior jaw (case 1) due to bilateral projections of the inferior corticonuclear pathways. Postictally, the main clinical sign was pseudobulbar palsy, consistent with Todd's palsy. In our cases, OMASE was either of vascular (cases 1 and 2) or tumoral origin (case 3). In adulthood, early recognition of OMASE, although nonspecific, may be important for early management of carotid occlusive disease because it usually indicates an acute opercular infarction.

Adult↗
PubMed1986

Longissimus muscle quality, palatability and connective tissue histological characteristics of bulls and steers fed different energy levels and slaughtered at four ages.

One hundred forty-four Angus male calves were assigned to one of five slaughter-age groups: 9, 12, 15, 18 and 24 mo of age. After weaning, one-half of the calves within slaughter age were castrated. One-half of the 12-, 15-, 18- and 24-mo age groups of each sex were further randomly allotted to a high-energy (HE) or low-energy (LE) finishing diet. Eight bulls and eight steers assigned to the 9-mo slaughter group were fed the HE diet only. Samples from the longissimus muscle (LM) were taken at the 12th rib for histological evaluations of fat deposits. Thin sections from the LM at the 11th rib were stained for lipid, collagen and elastin. Steaks from the LM were cooked and evaluated by a sensory panel and sheared by a Warner-Bratzler shear (WBS) device. The 9-10-11th rib sections were separated into muscle, fat and bone. Collagen, elastin and collagen solubility were determined chemically. Bulls had heavier carcasses, less fat and lower sensory scores for tenderness and juiciness than steers. Steers fed the HE diet had lower WBS values than bulls on either diet. Cooking losses were higher for bulls at 12, 18 and 24 mo than for steers. Histological evaluation showed that collagen content was higher for bulls than for steers and higher for cattle fed the LE diet than those fed the HE diet. Among cattle on the HE diet, the 9-mo cattle had more collagen than all older groups. Neither sex nor diet had an effect on elastin content shown by histological evaluation, but 12-mo cattle had the most elastin and the 15- and 18-mo cattle had the least elastin. Collagen content determined by chemical analysis was not affected by sex, diet or slaughter age. Correlation coefficients among histologically and chemically evaluated collagen and elastin and meat traits were too low to be of practical importance. The time-intensive histological techniques used in our study provided little additional information over that obtained from visually evaluated or chemically measured meat traits.

Adipose Tissue↗