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PubMed1996

The functional palatorrhaphy in the treatment of obstructive sleep apnoea.

We have developed a new operation for the surgical treatment of obstructive sleep apnoea, which we called functional palatorrhaphy. This preserves the posterior border of the soft palate and allows a controlled repair of the aponeurosis of the soft palate muscle. We combine the palatorrhaphy with a standard or a modified chin osteotomy with advancement of the base of tongue. In our first five treated and re-evaluated patients with severe obstructive sleep apnoea syndrome, who did not respond to conservative treatment, the operation was successful. All patients but one were considerably improved or cured of their symptoms.

Chin↗
PubMed1983

Hemipalatal palsy and microtia.

Unilateral microtia is not a separate entity but rather a part of the syndrome of hemifacial microsomia. To document the high incidence of hemipalatal palsy among microtia patients, 19 patients with unilateral microtia are reviewed. Partial innervation of the levator veli palatini muscle by the VII cranial nerve, and origin of this muscle from the second branchial arch, are suggested as the basis of the inclusion of hemipalatal palsy in hemifacial microsomia.

Child↗
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↗
PubMed1993

Influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway.

Increased retropalatal airway resistance may be caused by a sleep-induced loss of palatal muscle activity and a diminished ability of these muscles to respond to the increasing intrapharyngeal negative pressure that develops during sleep. To investigate these possibilities, in six normal subjects, we determined the effect of non-rapid-eye-movement sleep on 1) the tensor palatini (TP) electromyogram (EMG) response to rapid-onset negative-pressure generations (NPG) in the upper airway and 2) the collapsibility of the retropalatal airway during these NPGs. During wakefulness, the change in TP EMG from basal to peak levels (during NPG) was 19.8 +/- 3.2 arbitrary units (P < 0.005). This was markedly reduced during sleep (3.6 +/- 1.5 arbitrary units; P < 0.001). The latency of the TP EMG response was 48.5 +/- 5.6 ms during wakefulness but was prolonged during sleep (105.0 +/- 12.2 ms; P < 0.02). The peak transpalatal pressure during NPG (a measure of airway collapse) was 2.1 +/- 0.7 cmH2O during wakefulness and increased to 5.3 +/- 0.8 cmH2O during sleep (P < 0.05). We conclude that the brisk reflex response of the TP muscle to negative pressure during wakefulness is markedly reduced during non-rapid-eye-movement sleep, in association with a more collapsible retropalatal airway. We speculate that the reduction in this TP reflex response contributes to retropalatal airway narrowing during sleep in normal subjects.

Adult↗
PubMed1983

The anatomy of the eustachian tube in the rat: a macro- and microscopical study.

The rat eustachian tube (ET), from the nasopharyngeal orifice to the tympanal orifice, is about 4.5 mm long, of which the naso-medial membranous part (the nasopharyngeal orifice) measures about 1.5 mm and the occipito-lateral bony portion about 3 mm. The nasopharyngeal orifice is surrounded by two soft, lip-like, mucosal swellings--one ventral and one cranial--both easily mobile. The muscles related to the tubal opening mechanisms are the salpingopharyngeus, the tensor veli palatini and the levator veli palatini muscles. The salpingopharyngeus muscle originates partly from the cranial lip, whereas the palatal muscles originate partly from the ventral lip. The tympanal two thirds of the mucosal lining of the ET is cranially guided by a cartilage and incompletely framed by bony structures. The tympanal orifice is situated in the nasal part of the medial wall, well above the floor of the bulla. The tensor tympani muscle does not seem to take part in the opening and closing mechanisms of the ET. The mucosal lining of the ET consists of a respiratory epithelium with numerous glands in the lamina propria. It is suggested that the tubal muscles control the passage through the ET by moving the lip-like folds of the nasopharyngeal orifice. The anatomy of the rat ET is comparable to that described in Homo and it can be concluded that the rat ET might be a good model for studying the function of the human ET.

Animals↗
PubMed1997

Cerebellar axial postural tremor.

Three cases are presented with a predominantly axial postural tremor, without visible palatal tremor. Tremor varied in frequency between 3 and 10 Hz, often jumping from one frequency to another in this band. All three patients had evidence of cerebellar pathology. Cases 1 and 2 developed tremor in the setting of a late-onset cerebellar degeneration and after excision of a right cerebellar haemangioblastoma, respectively. Etiology was unclear in Case 3. Nevertheless, this patient had a cerebellar dysarthria. The tremor was similar to that sometimes seen in conjunction with palatal tremor, and EMG studies in Case 3 demonstrated a subclinical modulation of palatal muscle activity simultaneous with the truncal tremor. It is suggested that an axial postural tremor may be due to pathology of the cerebellum and its outflow pathways, despite the absence of clinically apparent palatal tremor.

Adult↗
PubMed2006

Sox9 mRNA expression in the developing palate and craniofacial muscles and skeletons.

BACKGROUND: SOX9 is a critical transcription factor for chondrogenesis and sex determination. Haploinsufficiency mutations of Sox9 in humans lead to campomelic dysplasia. Inactivation of Sox9 in the craniofacial region of mice results in an absence of endochondral bones and in malformation of other structures. This suggests that Sox9 plays multiple roles in craniofacial development and these remain to be elucidated. In order to study the functions of Sox9 in craniofacial development, a preliminary expression examination was performed. MATERIAL AND METHODS: To detect the expression of Sox9 mRNA, antisense riboprobe was synthesized by in vitro transcription. Radioactive in situ hybridization was performed on sagittal and coronal sections of mice head from organogenesis to the early postnatal stage. RESULTS: It was found that Sox9 was expressed in multiple stages and distinct processes. Besides the expression in cartilage, it was seen in the fusing stage of palatogenesis. Sox9 was also present during differentiation and maturation of craniofacial muscles. In addition, it was observed in intramembranous skeletal elements at restricted sites and stage. CONCLUSIONS: The expression pattern suggests that Sox9 serves broad roles in craniofacial development.

Animals↗
PubMed1994

Results of cleft palate repair with the double-reverse Z-plasty performed by residents.

The double-reverse Z-plasty (Furlow) repair of soft palate clefts has the advantages of lengthening the soft palate while reconstructing the palatal muscle sling to optimize velopharyngeal function. Because soft tissue from the hard palate is not mobilized to lengthen the soft palate, this technique has an additional theoretic advantage of minimizing disturbances of maxillofacial growth. Cited disadvantages of the technique include increased technical difficulty and operating time compared with other procedures. We performed a retrospective study of 20 consecutive Furlow repairs of the soft palate performed by residents under supervision of one attending surgeon between 1989 and 1992. All children had complete cleft of the soft palate; 14 had incomplete cleft and six had complete cleft of the hard palate, which were repaired by a modified Von Langenbeck technique or with vomer flaps. Mean age of patients was 15 months, and mean operating time (including placement of pressure-equalizing tubes) was 162 minutes, with an average estimated blood loss of less than 25 ml. Average time until adequate oral intake was achieved was 1.7 days, and duration of hospitalization averaged 2.4 days. Immediate postoperative complications included transient tongue edema in one patient and atelectasis and pneumonia in one patient with multiple congenital anomalies. Delayed postoperative complications included symptoms of sleep apnea in four patients, which subsequently improved after tonsillectomy and/or superior adenoidectomy. Fistulas occurred in two patients (10%), which compares favorably with published results of other techniques. Preliminary functional evaluations reveal that all repairs appear to have adequate length and good mobility; speech evaluations are in progress.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed2006

Symptomatic palatal myoclonus with ear click after tick-borne meningoencephalitis.

We present a case of a 39-year-old patient, who was diagnosed and treated for a tick-borne meningoencephalitis. Three months after the treatment he started to complain of annoying, cracks-resembling, rhythmical sounds, coming from the inside of his head to both his ears. Physical examination revealed rhythmical oscillations of the soft palate with a frequency of 100-120 per minute and a clock ticking noise synchronic with the palate tremor. Electromyography revealed continuous motor unit activity at rest in the tensor veli palatini muscle. Palatal myoclonus (PM) as a result of tick-borne meningoencephalitis was diagnosed. Treatment with several medications was started with no effect, then botulinum toxin was administered under EMG guidance to both sides of the patient's soft palate with great improvement. A 5-year follow-up and continuation of botulinum toxin injections with only minor and reversible side effects proved the treatment efficacy and safety. In the article we present a case of symptomatic palatal myoclonus with ear click and shortly discuss its aetiology, types and treatment options. We also stress the efficacy and safety of PM treatment with repetitive injections of botulinum toxin.

Adult↗
PubMed1999

A single surgeon's experience with the Delaire palatoplasty.

The purpose of this review was to evaluate the clinical outcomes regarding velopharyngeal insufficiency and fistulization in patients with cleft palate who underwent primary repair with the one-stage Delaire palatoplasty. All patients who had a primary Delaire-type palatoplasty performed by the senior surgeon over a 10-year period (1988 to 1998) were studied. During this period, each consecutive patient with an open palatal cleft underwent the same type of repair by the same surgeon. Speech quality and velopharyngeal competence as determined by a single speech pathologist were recorded. A total of 95 patients were included in this series. The average length of follow-up was 31 months (range, 1 to 118 months). Average age at time of surgery was 13.3 months (range, 6 to 180 months). Thirty-one patients (32.6 percent) had significant associated anomalies. The average length of hospital stay was 1.9 days (range, 1 to 8 days) with a trend in recent years toward discharge on postoperative day 1. There were no intraoperative complications, either surgical or anesthetic. Three patients (3.2 percent) developed palatal fistula; none of them required repair. Six patients (6.3 percent) had velopharyngeal incompetence. In patients with more than 1 year of follow-up, the incidence of velopharyngeal incompetence was 9.2 percent (6 of 65). The incidence of fistula after the Delaire palatoplasty was lower than usually reported. The incidence of velopharyngeal incompetence requiring pharyngoplasty was equal to or lower than that seen after other types of palatoplasty, suggesting superior soft-palate muscle function attributable to approximation of the musculus uvulae. The Delaire palatoplasty results in a functional palate with low risk for fistula formation and velopharyngeal incompetence.

Child↗
PubMed1990

Flaps for cleft lip and palate surgery.

The advantages of palate repair by double opposing Z-plasty include excellent access for complete mobilization of the palatal muscles, construction of an overlapping muscle sling, and avoidance of the growth-limiting horseshoe-type scars of the hard palate that result from lateral relaxing incisions or pushback procedures. The excellent speech that results seems to justify use of the procedure. An Abbé flap designed to mimic the normal philtrum placed over an interlacing orbicularis reconstruction that is well supported superiorly can salvage a thin, scarred upper lip and improve its mobility. The lateral gingival flap provides excellent esthetic reconstruction of the cleft alveolus, secure cover over an alveolar bone graft, and ease closure of an anterior oronasal fistula.

Cleft Lip↗
PubMed1981

[Localization of laryngeal muscle motoneurons in rat (author's transl)].

Medullar localization of laryngeal motoneurons has been studied in rat using horseradish peroxidase (HRP) as a retrograde tracer. After enzyme injection in laryngeal muscles labelled neurons were found in the nucleus ambiguus (NA) from 0.5 mm caudal to 1.5 mm rostral to the obex. The presence of labelled cells in both NA after sectioning of left recurrent laryngeal nerve showed the existence of a contralateral projection from NA motoneurons. HRP labelled cells were spindle-shaped and multipolar, NA laryngeal motoneurons were located in a well defined columnar arrangement parallel to the middle line. Motoneurons that innervate pharyngeal and soft palate muscles were located in the anterior part of NA up to the caudal end of the nucleus facialis.

Animals↗
PubMed1998

Palatoplasty: Furlow's double reversing Z-plasty versus intravelar veloplasty.

OBJECTIVE: To evaluate the efficacy of Furlow's double reversing z-plasty (Furlow) versus intravelar veloplasty with longitudinal closure including palatal muscle reorientation (IVV). DESIGN: Retrospective, single-institution, single-surgeon comparison. PATIENTS: One hundred nineteen consecutive cleft palate patients were enrolled; 34 syndromic and 9 language-impaired patients were removed from speech and reoperation analysis. Furlow and IVV groups were similar with respect to sex and mean age at primary repair. INTERVENTIONS: One surgeon performed all surgery and one of two speech pathologists conducted language and speech evaluations at 3 years of age without prior knowledge of the surgical technique utilized. OUTCOME MEASURES: Outcome measures included frequency of palatal fistulae, speech abnormalities, and need for secondary pharyngoplasty procedures. RESULTS: Patients who had undergone IVV demonstrated a 34% higher incidence of hoarseness, nasal escape, and hypernasality at 3 years of age than did Furlow patients. These same patients likewise required significantly more secondary pharyngoplasty procedures. No significant difference was noted between fistulae frequencies. CONCLUSIONS: These findings suggest that Furlow palatoplasty may provide a better clinical outcome than intravelar veloplasty.

Cleft Palate↗