Ein neuer Aspekt zur Entstehung chronischer Mittelohrerkrankungen bei Patienten mit Gaumenspalte

Leuwer, R.; Henschel, Michele; Sehhati-Chafai-Leuwer, S.; Hellner, D; Eickhoff, W.

doi:10.1055/s-2007-996842

Cited by 12 publications

(5 citation statements)

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“…For example, displacement of the hamulus of the pterygoid bone during reconstructive surgery in patients with craniofacial disorders (i.e. cleft palate), may alter the 3D vector relationships of TVPM forces and thus compromise ET function 19–20 . In addition, the abnormal morphology of the cartilage, TVPM and LVPM may contribute to ET dysfunction in cleft palate infants and young children 17–18 .…”

Section: 0 Introductionmentioning

confidence: 99%

Three-dimensional finite element analysis of Eustachian tube function under normal and pathological conditions

Sheer

Swarts

Ghadiali

2012

Medical Engineering & Physics

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A primary etiological factor underlying chronic middle ear disease is an inability to open the collapsible Eustachian tube (ET). However, the structure-function relationships responsible for ET dysfunction in patient populations at risk for developing otitis media (OM) are not known. In this study, three-dimensional (3D) finite element (FE) modeling techniques were used to investigate how changes in biomechanical and anatomical properties influence opening phenomena in three populations: normal adults, young children and infants with cleft palate. Histological data was used to create anatomically accurate models and FE techniques were used to simulate tissue deformation and ET opening. Lumen dilation was quantified using a computational fluid dynamic (CFD) technique and a sensitivity analysis was performed to ascertain the relative importance of the different anatomical and tissue mechanical properties. Results for adults suggest that ET function is highly sensitive to tensor veli palatini muscle (TVPM) forces and to periluminal mucosal tissue (PMT) elasticity. Young children and cleft palate subjects exhibited reduced sensitivity to TVPM forces while changes in PMT stiffness continued to have a significant impact on ET function. These results suggest that reducing PMT stiffness might be an effective way to restore ET function in these populations. Varying TVPM force vector relationships via changes in hamulus location had no effect on ET opening in young children and cleft palate subjects but did alter force transmission to the ET lumen during conditions of elevated adhesion. These models have therefore provided important new insights into the biomechanical mechanisms responsible for ET dysfunction.

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Section: 0 Introductionmentioning

confidence: 99%

Three-dimensional finite element analysis of Eustachian tube function under normal and pathological conditions

Sheer

Swarts

Ghadiali

2012

Medical Engineering & Physics

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“…Its function, especially after cleft palate surgery, has already been demonstrated. 12 The second hypomochlion is the so‐called “Ostmann's fatty tissue” laterally to the auditory tube ( elastic/passive ). Its effect on the muscular compliance was first described by Pahnke.…”

Section: Discussionmentioning

confidence: 99%

The Muscular Compliance of the Auditory Tube: A Model‐Based Survey

et al. 2002

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“…Some surgeons prefer to fracture the pterygoid hamulus to reduce the tension on the mucosal incision. However, this step inevitably affects the muscles and tendons around the pterygoid hamulus and is thought to damage velopharyngeal function and middle ear ventilation (Leuwer et al, 1995). In contrast, other surgeons prefer to transect the palatine aponeurosis to achieve the same tension reduction without damaging the hamulus.…”

Section: Introductionmentioning

confidence: 99%

Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus

Zhao

Wang

et al. 2021

The Cleft Palate Craniofacial Journal

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Objective Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus. Design Cadaveric specimens were stained with iodine–potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model. Results Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus. Conclusions Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.

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Ein neuer Aspekt zur Entstehung chronischer Mittelohrerkrankungen bei Patienten mit Gaumenspalte

Abstract: Chronic middle ear disease with cleft palate patients is basically caused by impaired muscular compliance of the Eustachian tube. Thus integrity of hamulus as well as tensor veli palatini muscle must become of crucial interest in cleft palate surgery.

Cited by 12 publications

References 0 publications

Three-dimensional finite element analysis of Eustachian tube function under normal and pathological conditions

Three-dimensional finite element analysis of Eustachian tube function under normal and pathological conditions

The Muscular Compliance of the Auditory Tube: A Model‐Based Survey

Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus

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