Histologic Study of the Normal Human Adult Soft Palate

Kuehn, David P.; Kahane, Joel C.

doi:10.1597/1545-1569_1990_027_0026_hsotnh_2.3.co_2

Cited by 37 publications

(41 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This observation is consistent with previous findings. Numerous authors have reported a broad extension of the muscle fibers as they enter the velum (Dickson et al, 1974; Boorman and Sommerlad, 1985; Kuehn and Kahane, 1990; Carrasco, 1996; Huang et al, 1998). However, from the present study, it appears that the fibers do not broaden to the greatest extent until the midline of the velum (measure point 6), as opposed to the velar insertion point (measure point 4).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Morphology of the Levator Veli Palatini Muscle Using Magnetic Resonance Imaging

Perry

Kuehn

Sutton

2013

The Cleft Palate Craniofacial Journal

Self Cite

View full text Add to dashboard Cite

Background No studies have reported the circumference and diameter of the levator veli palatini muscle at multiple points along its length and from both views (frontal and lateral). The purpose of this study was to provide quantitative data regarding the levator muscle morphology along the length of the muscle using magnetic resonance imaging and advanced three-dimensional computer technology. Methods Ten Caucasian male subjects participated in the study. Subjects were scanned using a Siemens 3 T Trio. Levator muscle measures were obtained using a two-dimensional image plane. A three-dimensional model was used to measure the circumference and muscle diameter (in two directions) at six points along the length of the levator muscle. Results Levator muscle length ranged from 41.67 mm to 52.85 mm across all subjects. Mean extravelar muscle length was 30.55 mm (SD, 2.8 mm) and 30.01 mm (SD, 2.9 mm) for right and left muscles. The mean circumference at the origin was 18.90 mm (SD, 2.6 mm). At the second point, the muscle circumference mean increased slightly (mean, 22.40 mm; SD, 4.9 mm). The means for the remainder of the measures (points 3, 4, 5, and 6) were consistent, showing little to no change. Conclusion Circumference and diameter values were similar to those reported in previous literature. The muscle did diverge at the point where the muscle bundle entered the velum, as it has been previously described. Instead, the muscle diverges near the midline insertion becoming sparser (smaller superior-to-inferior diameter).

show abstract

Section: Discussionmentioning

confidence: 99%

“…From the sagittal view, the muscle inserts into the velum at a 45° angle relative to a vertical reference line (Moon and Kuehn, 2004). It is said to have a broad insertion as it extends into the velum (Dickson et al, 1974; Boorman and Sommerlad, 1985; Kuehn and Kahane, 1990; Carrasco, 1996; Huang et al, 1998). …”

Section: Introductionmentioning

confidence: 99%

Morphology of the Levator Veli Palatini Muscle Using Magnetic Resonance Imaging

Perry

Kuehn

Sutton

2013

The Cleft Palate Craniofacial Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…Specifically, the four morphologic categories were i) noncleft single subject-specific model (“Long MU model”), ii) noncleft single subject-specific model with an MU that is modified to a shorter length (“Short MU model”), iii) noncleft single subject-specific model with the MU removed (“No MU model”), and iv) noncleft single subject-specific model with the MU removed and a midline velar defected added (“Midline defect model”). In the healthy noncleft single subject-specific model, MU was 3cm long, based on previous histological studies, where the MU extends down to the uvular base 5,7,11 . The diameter of the MU at the middle was 2.5mm, based on a previous study 3 , and the thickness tapered down as it coursed distally (to simulate that the fibers become more dispersed distally 5 ).…”

Section: Methodsmentioning

confidence: 99%

“…The MU functions to add stiffness to the velum and to rotate the velum toward the posterior pharyngeal wall. 3 The noncleft MU has been examined in dissection 2,4–6 , histological 7–11 , electromyography (EMG) 3 , and MRI 12,13 studies. Studies in adults and infants with cleft palate 1,14 and submucous cleft palate 15,16 have demonstrated consistent abnormality in the nasal surface of the velum.…”

Section: Introductionmentioning

confidence: 99%

Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model

Inouye

Lin

Perry³

et al. 2016

Annals of Plastic Surgery

View full text Add to dashboard Cite

The convexity of the dorsal surface of the velum is critical for normal velopharyngeal (VP) function and is largely attributed to the levator veli palatini (LVP) and musculus uvulae (MU). Studies have correlated a concave or flat nasal velar surface to symptoms of VP dysfunction including hypernasality and nasal air emission. In the context of surgical repair of cleft palates, the MU has been given relatively little attention in the literature compared with the larger LVP. A greater understanding of the mechanics of the MU will provide insight into understanding the influence of a dysmorphic MU, as seen in cleft palate, as it relates to VP function. The purpose of this study was to quantify the contributions of the MU to VP closure in a computational model. We created a novel 3D finite element model of the VP mechanism from MRI data collected from an individual with healthy non-cleft VP anatomy. The model components included the velum, posterior pharyngeal wall (PPW), LVP, and MU. Simulations were based on the muscle and soft tissue mechanical properties from the literature. We found that, similar to previous hypotheses, the MU acts as i) a space-occupying structure and ii) a velar extensor. As a space-occupying structure, the MU helps to nearly triple the midline VP contact length. As a velar extensor, the MU acting alone without the LVP decreases the VP distance 62%. Furthermore, activation of the MU decreases the LVP activation required for closure almost three-fold, from 20% (without MU) to 8% (with MU). Our study suggests that any possible salvaging and anatomical reconstruction of viable MU tissue in a cleft patient may improve VP closure due to its mechanical function. In the absence or dysfunction of MU tissue, implantation of autologous or engineered tissues at the velar midline, as a possible substitute for the MU, may produce a geometric convexity more favorable to VP closure. In the future, more complex models will provide further insight into optimal surgical reconstruction of the VP musculature in normal and cleft palate populations.

show abstract

“…6, 7 The velum consists of several distinct layers with characteristic components: 1) an oral mucosa layer containing mostly glandular tissue, 2) a middle muscle layer consisting of longitudinal fibers of the musculus uvulae and transverse fibers of the levator veli palatini, 3) a superoanterior layer consisting primarily of the tensor veli palatini tendon, 4) a posteroinferior layer (uvula proper) consisting of a mixture of glandular, and 5) the nasal mucosa. 8, 9 Careful tissue handling and management of each of these components are important to an intact and functional repair of cleft palate defects.…”

Section: Introductionmentioning

confidence: 99%

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Nguyen

Patel

Parikh

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

View full text Add to dashboard Cite

INTRODUCTION This biomechanical study aims to characterize the nasal mucosa during palatoplasty, describing the soft tissue attachments at different zones and quantifying movement following their release. METHODS Palatal nasal mucosa was exposed and divided in the midline in 10 adult cadaver heads. Five consecutive maneuvers were performed: (1) elevation of nasal mucosal off the maxilla; (2) dissection of nasal mucosa from soft palate musculature; (3) separation of nasal mucosa from palatine aponeurosis; (4) release of mucosa at the pterygopalatine junction; (5) mobilization of vomer flaps. The mucosal movements across the midline at the midpalate and posterior nasal spine following each maneuver were measured. RESULTS At the midpalate, maneuvers 1–4 cumulatively provided 3.8 mm (36.9%), 4.9 mm (47.6%), 6.1 mm (59.2%), and 10.3 mm, respectively. Vomer flap (10.5 mm) elevation led to mobility equivalent to that of maneuvers 1–4 (p=0.72). At the posterior nasal spine, cumulative measurements after maneuvers 1–4 were 1.3 mm (10%), 2.4 mm (18.6%), 5.7 mm (44.2%), and 12.9 mm. Here, vomer flaps (6.5 mm) provided less movement (p<0.001). Maneuver 4 yielded the greatest amount of movement of the lateral nasal mucosa at both the midpalate (4.2 mm, 40.8%) and posterior nasal spine (7.2 mm, 55.8%). CONCLUSION At the midpalate, complete release of the lateral nasal mucosa achieves as much movement as the vomer flap. At the hard-soft palate junction, the maneuvers progressively add to the movement of the lateral nasal mucosa. The most powerful step is release of attachments along the posterior aspect of the medial pterygoid.

show abstract

Histologic Study of the Normal Human Adult Soft Palate

Cited by 37 publications

References 17 publications

Morphology of the Levator Veli Palatini Muscle Using Magnetic Resonance Imaging

Morphology of the Levator Veli Palatini Muscle Using Magnetic Resonance Imaging

Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Contact Info

Product

Resources

About