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At least 163 records · Page 9Linked to original sources
PubMed2005

Revised uvulopalatopharyngoplasty with uvula preservation and its clinical study.

OBJECTIVES: A revised uvulopalatopharyngoplasty (UPPP) is reported for reducing the surgical complications without compromising the response. METHODS AND MATERIALS: A new method of performing UPPP was designed, in which the uvula is preserved, but a larger portion of the soft palate is removed. This new procedure is called the 'revised UPPP with uvula preservation' (Han's UPPP or H-UPPP), the characteristics of which are as follows: complete preservation of the uvula; larger portion of the soft palate resected (with the levator palati and tensor palati remaining intact); the adipose tissue in the space of the velum palati is removed; the preserved uvula will become a 'normal' one by the contraction of scar tissue on both sides of the musculus palato-uvularis and the lower margin of the tensor palati. 68 cases of obstructive sleep apnea/hypopnea syndrome had been treated with H-UPPP between September 1998 and May 2001. RESULTS: Polysomnography was performed for all 68 cases 6 months postoperatively with a surgical response of 69.12%, defined as a >50% reduction of the apnea-hypopnea index and <20 apneic pauses/h; no palatopharyngeal incompetency or palatopharyngeal stenosis. Anatomic measurements showed that the preserved uvula in H-UPPP begins to retract 2 weeks postoperatively, and the preserved uvula becomes 'normal' in 3-6 months. CONCLUSIONS: These results suggest that H-UPPP is an effective surgery and produces fewer complications compared with the classic UPPP.

Adipose Tissue↗
PubMedDate not supplied

The tensor tympani, stapedius, and tensor veli palatini muscles--an electromyographic study.

Electromyographic recordings of the activity of the tensor veli palatini, tensor tympani, and stapedius muscles were obtained from several adult human subjects. Muscle responses were recorded under four stimulus conditions, ie, contralateral intense wide-band noise, air jet to the eye, swallow, and electrical stimulation of the tongue. The results indicated that the two tensor muscles responded to the same stimuli in similar patterns. The latter muscle differed from the response of the stapedius.

Acoustic Stimulation↗
PubMed1992

The riddle of the uvula.

Since ancient times, the uvula has been a subject of interesting and contradictory observations. On the one hand, it was regarded as having a functional role in speech and in immunology, but on the other hand it was regarded as a potentially hazardous organ, possibly responsible for sudden infant death syndrome. None of these hypotheses, however, has been proved. In a previous study on patients undergoing uvulopalatopharyngoplasty, we suggested that the most important function of the uvula is connected with the muscularis uvula. Its function could be related to drinking while bending over. This previous assumption was that the uvula is a phylogenetic remnant from mammals that drink while bending their neck downward. In the present study, the soft palate of eight different mammals was macroscopically and microscopically studied and compared. Of all animals in the study, a small underdeveloped uvula was found only in two baboons. We found that the human uvula consists of an intermix of serous and seromucous glandular masses, muscular tissue, and large excretory canals. The serous and seromucous glands are absent in the other mammals. Thus, the uvula is a highly sophisticated structure, capable of producing a large quantity of fluid saliva that can be excreted in a short time. Both uvula and speech serve to differentiate human beings from animals. Our conclusion is that the uvula is possibly an accessory organ of speech, and may be another marker of human evolution that differentiates man from other mammals.

Animals↗
PubMed2005

Cyclic motion of the soft palate in feeding.

The soft palate moves rhythmically during feeding, but the timing and frequency of this motion are not known. We tested the hypothesis that cyclic soft palate motion is temporally linked to cyclic jaw movement. Nine healthy, asymptomatic human subjects with normal dentition ate solid food coated with barium. Videofluorographic recordings showed that rhythmic motions of the soft palate during mastication were linked temporally to jaw motion. Soft palate motion occurred in every recording but not in every jaw cycle. The soft palate moved upward as the jaw opened, but the nasopharynx was not sealed. During swallowing, however, the soft palate invariably elevated during the intercuspal phase of jaw motion, sealing the nasopharynx. The frequency of soft palate cycles was lowest early in a feeding sequence and gradually increased as the sequence progressed from ingestion to swallowing. We conclude that cyclic movement of the soft palate in feeding is temporally linked to jaw motion.

Adult↗
PubMed1991

Epileptic palatal myoclonus.

Palatal myoclonus (PM) is usually caused by lesions of the brainstem. We report a case of PM of focal cortical origin in a patient with epilepsia partialis continua. The PM sometimes occurred in isolation, and at other times was accompanied by unilateral face, neck, and arm twitching. This was documented by both EEG and SPECT.

Adolescent↗
PubMed1996

Ear clicks in palatal tremor caused by activity of the levator veli palatini.

We describe a patient who developed palatal tremor and presented with ear clicks that appeared to originate from activity of the levator veli palatini and not the tensor veli palatini. This was treated with botulinum toxin. We discuss the motor innervation of the palate in the context of our case, our findings in terms of classification, and how the lower cranial nerve nuclei are involved in the etiology of palatal tremor.

Adolescent↗
PubMed1980

Tongue strength Part I: Following total laryngectomy.

Surgical repositioning of the genioglossus muscle, as in total laryngectomy, may have an adverse effect on the protrusive strength of the tongue. To test this premise, anterior and lateral tongue strength measures were obtained from 10 laryngectomized and 15 normal subjects by means of a pressure transducer and recording device. The results indicated no significant difference between laryngectomized and normal subjects on tongue strength measures. Further, all laryngectomized subjects were judged to have good to excellent esophageal speech. It was concluded that laryngectomy does not adversely affect the major musculature concerned with protrusive tongue strength for proficient esophageal speakers.

Adult↗
PubMed1993

Transpalatal advancement pharyngoplasty for obstructive sleep apnea.

Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue-base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 +/- 12.2 to 12.3 +/- 2.8 events per hour. For the entire group, RDI decreased from 73.3 +/- 29.4 to 25.1 +/- 28.2 events per hour (P < .001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in careful selected patients as part of the surgical treatment of OSA.

Adult↗
PubMed2005

Obturators for cleft palate and other speech appliances.

An outline is given of palato-pharyngeal function in the cleft palate patient and how it may be expected to vary from that of the non-cleft subject. The procedure of obturator moulding is described and the functioning of palatal training appliances and palatal supports explained.

Cleft Palate↗
PubMed2004

Veloplasty using the wave-line technique versus classic intravelar veloplasty.

OBJECTIVE: A well-known problem in primary surgery of the soft palate is its shortness and the deficit of local soft tissue. This article introduces a modification of the primary intravelar veloplasty, allowing lengthening of the soft palate, and compares this alternative technique to the classic intravelar veloplasty. METHOD: The soft palate wave-line technique adds a wavy incision at the velar cleft margins to the intravelar veloplasty. In 24 patients with complete clefts of the palate, either the newly developed or classic technique was performed. Four years following primary surgery, speech performance and type of breathing were analyzed. RESULTS: Even in wide clefts of the soft palate, repair was easily accomplished using the wave-line technique. Complete closure of the nasal, muscular, and oral layers was achieved, and no postoperative fistula was observed. An average lengthening of the soft palate of 56% (range 24% to 83%) was observed immediately following velar repair with the wave-line technique. Speech was significantly better in the wave-line group (p <.05). Furthermore, physiological breathing was observed more often in these patients. CONCLUSION: Primary repair of clefts of the soft palate using the wave-line technique is straightforward, safe, and easy. On the basis of the present results, this technique seems superior to the classic intravelar veloplasty.

Articulation Disorders↗
PubMed2006

Cleft palate repair using a marginal musculo-mucosal flap.

OBJECTIVE: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. METHODS: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. RESULTS: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. CONCLUSIONS: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non-push-back method of hard palate repair.

Biological Dressings↗
PubMed2006

Congenital fenestration of the palate: A case of embryologic syzygy.

Congenital fenestration of the secondary palate is the rarest type of facial cleft. Of the 26 putative cases in the literature, only 5 had confirmation of the cleft during the neonatal period. This report documents such a cleft in an infant and presents the likely pathogenesis.

Cleft Palate↗
PubMed1990

Histologic study of the normal human adult soft palate.

Detailed information about the tissue components of the soft palate is needed to construct biomechanical models that are functionally useful. Soft palates were removed from 10 adult cadavers, four males and six females. One-half of each palate was further divided into 10 blocks of equal anterior-to-posterior thickness. The face of each block was sectioned and stained using three different stains, thus providing a sample of 300 histologic slides. Each slide was carefully examined and major anatomic characteristics were noted and recorded. The results indicate that a typical adult soft palate consists of several major tissue layers including: (1) the oral aspect, which is glandular with a zone of adipose tissue located somewhat laterally; (2) the two middle layers are muscular with the more inferior layer consisting mainly of transverse levator veli palatini fibers and the overlying longitudinal layer of musculus uvulae fibers; (3) a superoanterior layer consisting of the tensor veli palatini tendon; and (4) a posteroinferior layer consisting of a mixture of tissue that is primarily glandular. The oral mucosa consists of stratified squamous epithelium with a basement membrane that is reinforced with a dense meshwork of elastic fibers. The nasal mucosa consists of pseudostratified ciliated columnar epithelium anteriorly and stratified squamous epithelium posteroinferiorly. The functional implications of these findings are discussed.

Adipose Tissue↗
PubMed1990

The morphometry and three-dimensional structure of the adult eustachian tube: implications for function.

An accurate description of the functioning Eustachian tube (ET) requires a thorough knowledge of the anatomic relationships of its components. To this end, 15 "normal" adult ETs were obtained, sectioned, and stained with hemotoxylin-eosin. Descriptive and quantitative data of ET structures and their relationships were obtained. Eustachian tube length was normalized and comparisons between specimens made. This analysis suggests (1) in its midsection the cartilage is loosely attached to the cranial base; (2) the deep portion of the tensor veli palatini (TVP) originates from the lateral lamina and the fibrous portion of the lateral membraneous wall; and (3) the levator veli palatini (LVP) can interact with the ET primarily via the elongated medial lamina in the anterior portion of the ET. These observations suggest the ET is opened by a medial rotation of cartilage effected primarily by the TVP, but aided anteriorly by the LVP.

Adipose Tissue↗
PubMed1992

Evaluation of the sphincter pharyngoplasty.

The results of the sphincter pharyngoplasty were evaluated in 139 patients with velopharyngeal incompetence (VPI) who demonstrated active velar elevation. All patients underwent perceptual speech evaluation and lateral phonation radiographic study; select patients underwent multiview videofluoroscopic, flexible nasendoscopic, and pressure-flow studies. All but one patient demonstrated improvement and 109/139 (78.42%) demonstrated resolution of VPI. Sixteen of thirty failed pharyngoplasties were revised. Revision was successful in 8/16 patients yielding an overall success rate of 117/139 (84.17%). Success rate was 67.65 percent for patients managed during the first 5 years and improved to 84.78 percent for patients managed during the last 5 years of this 15-year series. Analysis revealed that younger patients were treated more successfully than older patients, large velopharyngeal areas were treated as successfully as smaller ones, and circular closure patterns were treated more successfully than coronal patterns. The primary cause of failure was insertion of the flap below the point of attempted velopharyngeal contact.

Adolescent↗
PubMed1993

Submucous cleft palate with a discontinuous bony deformity.

An unusual submucous palatal cleft is presented. In addition to the usual triad of bifid uvula, posterior bony notching, and diastasis of the velar musculature, there was a linear bony cleft involving only the maxillary component of the hard palate. The palatine bone was intact between the posterior notch and the maxillary cleft. A discontinuous palatal cleft is an extremely rare deformity and is interesting because existing theories of cleft pathogenesis do not readily explain such a defect.

Child, Preschool↗