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PubMed1997

Structure of the musculus uvulae: functional and surgical implications of an anatomic study.

OBJECTIVE: The role of the musculus uvulae in velopharyngeal function, its morphologic status in cleft palate, and its fate in palatoplasty procedures are subjects of controversy. The aims of this investigation were to re-examine this velar muscle to clarify its anatomic characteristics, to analyze its role in speech physiology, and to study the surgical implications of this information for cleft palate repair. METHODS: Its attachments, morphology, and relations were examined in 18 fresh human adult cadavers by detailed dissection under 3.2x magnification and light microscopy. RESULTS: The musculus uvulae was observed to be a paired midline muscle extending between the tensor aponeurosis anteriorly and the base of the uvula posteriorly along the nasal aspect of the velum. It had no attachments to the hard palate. CONCLUSIONS: These findings suggest that its action is to increase midline bulk on the nasal aspect of the velum, thus contributing to the levator eminence. It may also have an extensor effect on the nasal aspect of the velum, displacing it toward the posterior pharyngeal wall. Both of these actions would serve to maximize midline velopharyngeal contact. One clinical application of this anatomic information is that the muscle should be preserved in the dissection performed during intravelar veloplasty. Furthermore, it should be recognized that the musculus uvulae is invariably divided and reoriented incorrectly in the Furlow double opposing Z-plasty.

Adult↗
PubMed2006

[Clinical application of uvulopalatopharyngoplasty with uvula preservation and tongue base radiofrequency reduction].

OBJECTIVE: To explore the effect of uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction for obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Forty six patients with OSAHS were enrolled. One group (n = 22) of patients only received uvulopalatopharyngoplasty with uvula preservation, while the other group (n = 24) had both uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction. Polysomnography and distance between anterior pillars (DBAP), distance between posterior pillars (DBPP), length of roft palate, distance between tongue base and posterior pharyngeal wall (DBTP) were measured before and 6 months after surgery. RESULTS: The pre-operation apnea hypopnea index (AHI), x +/- s, lowest SaO2 (LSaO2) of first group were (56. 5 +/- 6. 0)/h, and 0.626 +/- 0.060 respectively, and 6 months after surgery, AHI was (23.7 +/- 2.7)/h, LSaO2 was 0.797 +/- 0.053. The pre-operation AHI, LSaO2 of second group were (58.4 +/- 5.1)/h, and 0.650 +/- 0.057 respectively, and 6 months after surgery, AHI was (15.5 +/- 3.2)/h, LSaO2 was 0.864 +/- 0.064. After surgery AHI and LSaO2 have changed in both groups (P<0.001). Six months after operation, DBAP and DBPP became withy, length of soft palate became short (P<0. 001). In one group the validity ratio is 72.7% (16/22), the other group the validity ratio is 87.5% (21/24) (P< 0.05), and pharyngeal posterior airway width (PPAW) became withy (P <0.001). CONCLUSIONS: For OSAHS patients, the obstructive regions should be evaluated. The combined surgery of uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction could have a better result.

Adult↗
PubMed1977

The morphology of musculus uvulae.

The morphology of the musculus uvulae was studied utilizing detailed gross anatomical dissection and histological sectioning of the soft palate in seven adult human cadavers. The results indicated that the musculus uvulae is paired as previously described in most anatomy texts. Each bundle takes origin lateral to the midline from the tendinous palatal aponeurosis posterior to the hard palate and just anterior to the insertion of the levator veli palatini muscle. The two bundles converge in an area overlying the sling of the levator muscle and course along the dorsum of the soft palate terminating as two separate bundles which subdivide and insert between the mucous glands of the uvula proper into the connective tissue and basement membrane of the mucosa. Becuase of its location and size, it appears that contraction of the musculus uvulae would add bulk to the dorsal surface of the elvated soft palate thus aiding in occlusion of the velophryngeal portal during speech and deglutition.

Aged↗
PubMed1978

The longitudinal fibromuscular component of the soft palate in the fifteen-week human fetus: musculus uvulae and palatine raphe.

The structural relationships of the longitudinal fibromuscular component of the soft palate (musculus uvulae and raphe) were studied using histologic sections from 19 early human fetal specimens. Musculus uvulae arises in association with the palatine aponeurosis near the beginning of the second quadrant of the velum, follows a sigmoid course, and terminates near the base of the uvula. In addition, an occasional muscular loop may arise from the bony palate, arch downwards, and then recur into the uvular muscle. A complex relationship exists between the raphe in the velum and several palatal muscles. With regard to musculus uvulae, small muscular bundles arise from the raphe to embrace the muscle near its crest. These branches may aid in contouring the dorsal surface of the velum in the region of the levator eminence to complement the surface of the posterior pharyngeal wall and thus enhance the efficiency of the velopharyngeal seal.

Connective Tissue↗
PubMed1988

An electromyographic study of the musculus uvulae.

The musculus uvulae and the levator veli palatini muscle were studied with electromyography (EMG) in three normal young adult subjects. Patterns of EMG activity for the musculus uvulae were similar to those of the levator veli palatini for all three subjects. When differences in EMG activity between the two muscles were found, the tasks did not involve speech. The presence of the musculus uvulae along the nasal aspect of the velum may be important in filling the space between the elevated velum and the posterior pharyngeal wall. In addition, the musculus uvulae may function to modify stiffness of the tissue adjacent to the insertion of the levator veli palatini and to produce extension of the velum.

Adult↗
PubMed1982

Mutilation of the uvula among Bedouins of the South Sinai.

Mutilation of the uvula, as practiced by various tribes of Bedouins in the South Sinai, was discovered while carrying out anthropological studies in the area. Partial or total amputation of the uvula is performed on both boys and girls during the first or second year of life, as a ritual custom. Anatomical changes in the soft palate due to the uvulectomy in 115 subjects are described. The remnant of the uvula (scar) was classified according to size as: very large, large, medium, small, trace or none. A notch or kind of cleft of the palate, as a result of the uvulectomy, was considered the most extreme degree of extirpation. The majority (47%) were of small size and a notch was found in 9.6%. Changes in shape and symmetry of the arches of the palate as a result of the uvulectomy are also described. These changes are explained on the basis of the anatomical structure of the palate and uvula. The possible effects of the uvulectomy on health in general and on speech in particular are discussed.

Adolescent↗
PubMed1996

The function of the cerebellar uvula in monkey during optokinetic and pursuit eye movements: single-unit responses and lesion effects.

The cerebellum is known to participate in visually guided eye movements. The cerebellar uvula receives projections from pontine nuclei that have been implicated in visual motion processing and the generation of smooth pursuit. Single-unit and lesion studies were conducted to determine how the uvula might further process these input signals. Purkinje cells and input fibers were recorded during a variety of visual and oculomotor paradigms. Most Purkinje cells were modulated in either an excitatory or inhibitory fashion by prolonged, horizontal optokinetic drum rotation. A small proportion of cells responded during smooth tracking of a small spot of light. As a paradox to the physiological data, lesions of the uvula produced a profound effect on smooth-pursuit eye movements. Initial eye velocity for pursuit in the direction contraversive to the lesion site was increased substantially following lesions in comparison with prelesion controls. The lesions also affected optokinetic nystagmus in the direction contraversive to the lesion, but not as drastically as they did pursuit. Overall the results suggest that the uvula is not in the neuronal pathway that directly controls pursuit, but instead serves to adjust the gain of this system as a result of abnormal periods of motion of the visual world.

Animals↗
PubMed1989

Olivary branching projections to the flocculus, nodulus and uvula in the rabbit. II. Retrograde double labeling study with fluorescent dyes.

The previous electrophysiological study reported that some of the Purkinje cells in the vestibulocerebellum were innervated by branching climbing fibers. To identify the cells of origin of these branching climbing fibers, a pair of retrograde fluorescent tracers, propidium iodide in combination with 4', 6-diamidino-2-phenylindole or diamidino yellow, were injected into two sites in the flocculus, nodulus and uvula. Proportions of double labeled neurons out of all labeled neurons in each subdivision of the contralateral inferior olive were studied. In cases of injections into the flocculus and nodulus, 13% (maximum 27%) of all the labeled neurons in the dorsal cap and 6% (maximum 12%) in the ventrolateral outgrowth were double labeled. In cases of injections into the nodulus and uvula, 20% neurons (maximum 34%) of the labeled neurons in the dorsal cap and 8% of those in the nucleus beta were double labeled. The present retrograde labeling study revealed that some dorsal cap neurons project to the uvula, which has not been reported previously in the rabbit. Injections into the flocculus and uvula caused only slight double labeling (0.4%) in the inferior olive.

Amidines↗
PubMed1994

Mossy fiber projections from the brain stem to the nodulus in the cat. An experimental study comparing the nodulus, the uvula and the flocculus.

Mossy fiber projections from the brainstem to the nodulus were studied by means of the retrograde transport of horseradish peroxidase (HRP) in the cat. The findings indicate exclusive secondary vestibular projections to the nodulus (96.5% of the total number of labeled cells in cat 1). Major sources of such projections include the caudal half of the medial and inferior vestibular nuclei, and the dorsal half of the superior vestibular nucleus. Groups-x and -z of the vestibular nuclei give rise to minor projections. The projections from groups-f and -y, and the interstitial nucleus of the eighth nerve are very few, if any. Minor extravestibular projections originate from the prepositus hypoglossal nucleus and the infratrigeminal nucleus. All these projections are bilateral. No other nuclei in the brainstem were labeled following HRP injection in the nodulus. No indications of mediolateral and dorsoventral differences in mossy fiber projections were found. There are quantitative differences in the sources of projections to the nodulus, the ventral uvula and the flocculus, all of which belong to the vestibulocerebellum. The largest sources for projections to the nodulus and the ventral uvula are from the vestibular nuclei. Among the vestibular nuclei, group-x provides the major projections to the ventral uvula. For the flocculus, in contrast, the major sources of input are the reticular formation and raphe nuclei. These quantitative differences may play an important role for differential functions of the nodulus, the ventral uvula and the flocculus.

Afferent Pathways↗
PubMed1989

Nodulus-uvula depressor response: central GABA-mediated inhibition of alpha-adrenergic outflow.

Electrical stimulation of a lateral region of the cerebellar nodulus-uvula transition zone in anesthetized albino rabbits decreases mean arterial blood pressure in direct proportion to stimulus intensity. The hypotension has an abrupt onset and is phasic; heart rate is unaffected. Neural pathways that might mediate the depressor response were studied using autonomic-blocking agents. Pretreatment with 2 mg/kg iv of either propranolol HCl or atropine methyl nitrate did not alter the onset or duration of the hypotensive response. However, pretreatment with 2 mg/kg iv phentolamine HCl abolished the depressor response, and 7 mg.kg-1.min-1 iv tetraethylammonium infusion decreased the response by more than 50%. Ipsilateral injections of 200 ng bicuculline methiodide into an area immediately dorsal to the superior cerebellar peduncle or the dorsal aspect of the superior vestibular nucleus reversibly attenuated the nodulus-uvula evoked depression. Anterograde horseradish peroxidase-wheat germ agglutinin (HRP-WGA) transport experiments revealed that both these regions receive direct inputs from the nodulus-uvula. These data suggest that hypotensive events elicited by lateral nodulus-uvula stimuli represent a central, alpha-aminobutyric acid-mediated, phasic inhibition of vasomotor drive mediated through autonomic ganglia to alpha-adrenoreceptors in the vasculature.

Animals↗
PubMed1992

Effect of anesthetic on sympathetic responses evoked from cerebellar uvula in decerebrate cats.

The sympathetic mechanisms involved in the conversion of the tachycardia-pressor response evoked by electrical stimulation of the uvula (lobule IX of the posterior cerebellar cortex) in the unanesthetized decerebrate cat to a bradycardia-depressor response in the same, but anesthetized preparation, were investigated. Sympathoexcitation was produced in the inferior cardiac and renal sympathetic nerves in response to short train stimulation (2-5 pulses, 100-500 Hz) of the uvula in the unanesthetized decerebrate cat, and when paired stimuli (conditioning and test) were applied, the test-evoked potential in both nerves was similar to the response elicited by the conditioning stimulus. Anesthetic administered to these same animals caused the test response in both sympathetic nerves to be greatly decreased, yet the conditioning response was unchanged. The attenuation of the test response by the conditioning stimulus diminished during recovery from anesthesia. The recovery of the test response paralleled the time course of the return of the tachycardia-pressor effect evoked by long train stimulation of the uvula. It appears that anesthesia does not block the sympathoexcitatory response but acts to augment sympathoinhibitory processes associated with uvula stimulation; some possible mechanisms are discussed.

Anesthetics↗
PubMed1989

[Afferent projections to the uvula in the cat. I. Climbing fiber projections].

The inferior olive afferents to the cerebellar uvula were studied by means of retrograde axonal transport of horseradish peroxidase (HRP) in the cat. Following large and small injections of HRP into the uvula, the distributions of labeled cells in the inferior olive were investigated. As to the climbing fiber projection, it is revealed that there are six longitudinal parasagittal zone extending throughout the dorsal and ventral uvula. That is, the caudal aspect of the nucleus beta projects to a most medially oriented zone (caudal beta zone), the rostral aspect of the nucleus beta projects to a zone (rostral beta zone) oriented lateral to the caudal beta zone, the caudal aspect of the medial accessory olive (MAO) projects to a zone oriented lateral to the rostral beta zone, the dorsomedial cell column projects to a zone (dorsomedial cell column zone) oriented in the intermediate part of the uvula, the ventral lamella of the principal olive (vlPO) projects to a more lateral zone (vlPO zone), and the rostral aspect of the MAO projects to the most lateral zone (rostral MAO zone).

Afferent Pathways↗
PubMed1987

Lack of association of cleft uvula with otitis media in Apache Indian children.

Cleft uvula occurs in approximately 20% of Athabaskan Indians. The association of cleft uvula with otitis media was examined in a cohort of 175 Apache Indian children followed up prospectively from birth. No association was found between the occurrence of cleft uvula and the rate, frequency, or timing of otitis media attacks.

Arizona↗
PubMed1985

Musculus uvulae and levator palati: their anatomical and functional relationship in velopharyngeal closure.

The morphological relationship between the musculus uvulae and levator palati muscles and their importance in velopharyngeal closure was studied in cadavers by simulation of levator action, palate serial section and dissection, and in various subjects by nerve stimulation and blockade. These studies support the cardinal importance of the levator muscles in velopharyngeal closure. The significance of musculus uvulae activity is less clear. While lesser palatine nerve stimulation evoked a response from the musculus uvulae, a nerve block produced no detrimental effect on speech or nasendoscopic appearance in normal subjects.

Adult↗
PubMed2000

Conditions of the uvula: a 14 years experience.

OBJECTIVE: A retrospective study to find out the aetiology, symptomatology and management of elongated and enlarged uvulae. MATERIALS AND METHODS: Examination of files of 375 patients seen in the period 1983-1997. RESULTS: Trauma constituted a big proportion of patients seen. However, papillomas, solitary infections, allergy, simple symptomatic elongation, squamous cell carcinoma as well as asympomatic elongation were seen. The symptomatology varied between simple irritation in the throat to vomiting, pain and dysphagia. CONCLUSION: Enlarged or elongated uvulae are rare but solitary involvement of uvula because of variety of causes occur.

Carcinoma, Squamous Cell↗
PubMed1987

Musculus uvulae and velopharyngeal status.

A study of velopharyngeal status after partial excision of musculus uvulae, as in total uvulectomy, has been carried out in 15 adults with normally formed soft palates. Fifteen volunteers matched for age and sex with normal palates, who had not had total uvulectomy, were used as controls. Four assessment techniques were used: Air escape, with modified tongue anchor technique; Production of speech sounds; Transnasal nasopharyngoscopy; and Radiological screening. Even though Azzam and Kuehn (1977) have stressed the importance of the musculus uvulae in velopharyngeal closure, all assessments showed that partial excision of the musculus uvulae, as in total uvulectomy, has no statistically significant effect on the velopharyngeal status in subjects with a normally formed soft palate.

Adult↗
PubMed1999

Structure of the human uvula.

Eleven uvular biopsies were investigated for their morphology, the presence of mast cells and the distribution of hyaluronan and its major ligand CD44. Three microanatomical sites--surface epithelium, subepithelial area and area of glands--were examined. The oral side of the uvula was covered by a 15-20 cell thick layer of keratinized/parakeratinized surface epithelium, firmly anchored to the underlying connective tissue by connective tissue papillae. The width of the intercellular spaces in the epithelium increased toward the basal lamina, a location that exhibited intense hyaluronan and anti-CD44 staining. Most mast cells were located in the vicinity of blood vessels, at which sites there was high staining intensity of hyaluronan. Tissue mast cells could also be observed in the connective tissue septa enclosing the acini. Glands and muscle fibres became more sparse from the proximal part of the uvula to the distal end, while the amount of connective tissue increased. The localization and architecture of connective tissue elements and mast cells are consistent with the ability of the uvula to resist mechanical stresses and to develop oedema and fibrosis, respectively.

Adult↗
PubMed2000

Human uvula: characterization of resident leukocytes and local cytokine production.

Upper airway infections often lead to macroscopic changes in the architecture of the uvula. Using immunomorphometric analysis, we investigated the frequency and distribution of immune cells and of cytokine-producing cells in uvular samples. Tissue macrophages, alphabeta T cells, gammadelta T cells, and B cells were, in declining order, the main cell populations. Gammadelta T cells and B cells exhibited reciprocal localization, with almost all gammadelta T cells residing in the vicinity of the epithelium, and all B cells in the glandular area. The presence of cells expressing the suppressor phenotype CD8+CD28- alphabeta T cells is suggested. Fifteen to twenty-five percent of the immune cells expressed the down-regulatory cytokine tumor growth factor beta. Most macrophages were located subepithelially, in the vicinity of the basal lamina. The composition and cytokine profile of leukocytes in the tissue suggest that the uvula may be a site, additional to the jejunal mucosa, for induction of mucosal tolerance to inhaled and ingested antigens. Concomitantly, the uvula appears to be protected from invasion of microbial pathogens by a subepithelial barrier of macrophages and gammadelta T cells.

Adult↗