DOCSLIB.ORG

Anatomy and Physiology of the Velopharyngeal Mechanism

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anatomy and Physiology of the Velopharyngeal Mechanism Anatomy and Physiology of the Velopharyngeal Mechanism Jamie L. Perry, Ph.D.1 ABSTRACT Understanding the normal anatomy and physiology of the velopharyngeal mechanism is the first step in providing appropriate diagnosis and treatment for children born with cleft lip and palate. The velopharyngeal mechanism consists of a muscular valve that extends from the posterior surface of the hard palate (roof of mouth) to the posterior pharyngeal wall and includes the velum (soft palate), lateral pharyngeal walls (sides of the throat), and the posterior pharyngeal wall (back wall of the throat). The function of the velopharyngeal mechanism is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities for various purposes, including speech. Velopharyngeal closure is accomplished through the contraction of several velopharyngeal muscles including the levator veli palatini, musculus uvulae, superior pharyngeal con- strictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. The tensor veli palatini is thought to be responsible for eustachian tube function. KEYWORDS: Anatomy, physiology, velopharyngeal muscles, cleft palate anatomy Downloaded by: SASLHA. Copyrighted material. Learning Outcomes: As a result of this activity, the reader will be able to (1) list the major muscles of the velopharyngeal mechanism and discuss their functions; (2) list the sensory and motor innervation patterns for the muscles of the velopharyngeal mechanism; and (3) discuss the variations in velopharyngeal anatomy found in an unrepaired cleft palate. Understanding the normal anatomy and and treatment for children born with cleft lip physiology of the velopharyngeal mechanism is and palate. Most of the diagnostic and therapy the first step in providing appropriate diagnosis approaches are based on a strong foundation of 1Department of Communication Sciences and Disorders, Guest Editor, Ann W. Kummer, Ph.D., CCC-SLP, Illinois State University, Normal, Illinois. ASHA-F. Address for correspondence and reprint requests: Jamie Semin Speech Lang 2011;32:83–92. Copyright # L. Perry, Ph.D., Department of Communication Sciences 2011 by Thieme Medical Publishers, Inc., 333 Seventh and Disorders, Illinois State University, 208 Rachel Avenue, New York, NY 10001, USA. Tel: +1(212) 584- Cooper, Normal, IL 61790 (e-mail: [email protected]). 4662. Communication Disorders Related to Cleft Palate, DOI: http://dx.doi.org/10.1055/s-0031-1277712. Craniofacial Anomalies, and Velopharyngeal Dysfunction; ISSN 0734-0478. 83 84 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 32, NUMBER 2 2011 the underlying anatomy. In addition, this pop- resonance image (MRI) of the velopharyngeal ulation continually presents with changes in the mechanism at rest and during speech produc- anatomy and physiology as the head and neck tion. The orifice or gap behind the velum is anatomy develops across childhood and called the ‘‘velopharyngeal port.’’ This is the through adolescence. Being able to identify distance that the velum and pharyngeal walls the important structures and know how these must overcome to have complete closure, such relate to normal and abnormal speech produc- as during speech and swallowing. Histological tion is a critical part of our ongoing evaluation studies show that the velum consists of a for such individuals. Although cleft palate mixture of tendinous, muscular, adipose, con- anatomy includes facial, oral, nasal, and phar- nective, and glandular tissue along the velar yngeal anatomy, the focus for this article is on length.3,4 The anterior two-thirds of the velum the structures and muscles related to the nor- appears to be consistent in its composition mal velopharyngeal mechanism as these struc- compared with the posterior one-third, which tures and muscles have the greatest impact on shows greater variability across individuals. speech and resonance. The purpose of this This demonstrates the importance of the ante- article is to provide an overview of normal rior two-thirds in providing the functional anatomy and physiology of the velopharyngeal components to the velum during velopharyng- mechanism and to provide a brief discussion of eal closure.5 how the anatomy is altered when there is a cleft palate. Function The function of the velopharyngeal mechanism VELOPHARYNGEAL MECHANISM is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal Orientation cavities. During speech, normal velopharyngeal The velopharyngeal mechanism consists of a closure is necessary to be able to produce oral muscular valve that extends from the posterior speech phonemes. Only three sounds in the surface of the hard palate (roof of mouth) to the English language, /m/, /n/, /ng/, are produced posterior pharyngeal wall.1 The mechanism with an open velopharyngeal port. includes the velum (soft palate), lateral phar- The velum extends from the posterior yngeal walls (sides of the throat), and the nasal spine of the hard palate to the uvula. posterior pharyngeal wall (back wall of the During nasal breathing, the oral surface is Downloaded by: SASLHA. Copyrighted material. throat).2 Fig. 1 shows a midsagittal magnetic down and rests against the back of the tongue Figure 1 Midsagittal magnetic resonance imaging of velopharyngeal mechanism at rest (A) and during speech production (B). The white arrow is pointing at the velar eminence during elevation. PPW, posterior pharyngeal wall. ANATOMY AND PHYSIOLOGY OF THE VELOPHARYNGEAL MECHANISM/PERRY 85 (Fig. 1A). During production of oral speech to contraction of the inferior fibers of the sounds, the velum is elevated and retracted to superior constrictor muscle.6 It can best be make complete contact against the posterior viewed on the lateral view of videofluoroscopy pharyngeal wall. As seen in Fig. 1B, when the but can also be seen with nasopharyngoscopy velum elevates it creates a ‘‘knee’’ or eminence when there is a large velopharyngeal opening. as it bends against the posterior pharyngeal wall It can even be viewed through an intraoral (white arrow on Fig. 1B). This creates a tight examination in some cases. Passavant’s ridge seal to redirect the sound and airflow into the is seen in children with a repaired cleft palate mouth instead of the nasal cavity. and also in individuals with normal anatomy. Closure of the velopharyngeal mechanism The existence of a Passavant’s ridge does not is primarily accomplished by retraction and mean that contact is achieved against this ridge. elevation of the velum. Movement of the phar- In most cases, the ridge is too low to assist with yngeal walls, however, also contributes to ve- velopharyngeal closure. lopharyngeal closure. Lateral pharyngeal wall Three basic types of closure have been movement toward the midline and anterior identified across individuals with normal movement of the posterior pharyngeal wall speech and also those with repaired cleft palate. help to create a sphincterlike closure pattern. Closure patterns include coronal, where the Some individuals may create velar contact closure occurs primarily due to the action of against an enlarged adenoid pad. This is more the velum, with less contribution of the lateral commonly observed in children before adenoid pharyngeal walls; circular, where all structures involution occurs during adolescence. Fig. 2 come together as ‘‘purse string’’; and sagittal, demonstrates a midsagittal MRI of this ad- where lateral pharyngeal wall movement is the enoid-to-velar contact in a 4-year-old child major component of closure.2,7 Passavant’s with normal anatomy. ridge is commonly seen with the circular pat- Some individuals have what is called a tern of closure. Closure pattern is best observed ‘‘Passavant’s ridge.’’ When a Passavant’s ridge through nasopharyngoscopy, which provides a is present, it appears as a shelflike structure that view from the top or nasal surface of the velum. bulges forward during speech and then disap- Fig. 3 demonstrates a coronal closure pattern pears at rest. Passavant’s ridge is felt to be due observed in an adult male in which the major movement is an upward and backward move- ment of the velum accompanied by a secondary component of lateral pharyngeal wall move- Downloaded by: SASLHA. Copyrighted material. ment. This is the most common pattern of closure observed in individuals with normal anatomy. NORMAL VELOPHARYNGEAL MUSCULATURE There are several velopharyngeal muscles, in- cluding the levator veli palatini, musculus uvu- lae, tensor veli palatini, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. These muscles are described below. Levator Veli Palatini Figure 2 Midsagittal magnetic resonance ima- The paired levator veli palatini muscle is the ging of a 4-year-old child with an enlarged adenoid most important muscle for normal velophar- pad (white arrow). yngeal closure.8 This muscle originates at the 86 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 32, NUMBER 2 2011 Figure 3 Nasopharyngoscopy demonstrating the velum, lateral pharyngeal walls (LPW), posterior pharyngeal wall (PPW) in the open (left image) and closed position (right image). Note the upward and backward movement of the velum and the medial movement of the lateral pharyngeal walls. base of the skull on each side, specifically the the levator veli palatini muscle from its origin petrous portion of the temporal bone. Accord- to insertion (Fig. 5). ing to Huang et al,8 part of the muscle may The function of the levator veli palatini originate at the junction of the cartilaginous
Load more

Recommended publications
  • Selecting Different Approaches for Palate and Pharynx Surgery
    SPECIAL ISSUE 4: INVITED ARTICLE Selecting Different Approaches for Palate and Pharynx Surgery: Palatopharyngeal Arch Staging System Rodolfo Lugo-Saldaña1 , Karina Saldívar-Ponce2 , Irina González-Sáez3 , Daniela Hernández-Sirit4 , Patricia Mireles-García5 ABSTRACT The examination of the anatomical structures involved in the upper airway collapse in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) is a key for integrated evaluation of patients. Our proposal is for a noninvasive classification system that guides us about the presence of anatomical differences between the palatopharyngeal muscle (PFM). The functions of the PFM are narrowing the isthmus, descending the palate, and raising the larynx during swallowing; these characteristics give the PFM a special role in the collapse of the lateral pharyngeal wall. Complete knowledge of the anatomy and classification of different variants can guide us to choose the appropriate surgical procedures for the lateral wall collapse. Until now there is not a consensus about description of the trajectory or anatomical variants of the PFM into oropharynx, the distance between both muscles, and the muscle tone. Here we also present the relationship between the lateral wall surgeries currently available (lateral pharyngoplasty by Cahali, expansion sphincteroplasty by Pang, relocation pharyngoplasty by Li, Roman blinds pharyngoplasty by Mantovani, and barbed sutures pharyngoplasty by Vicini) with the proposed classification of the palatopharyngeal arch staging system (PASS). Keywords:
    [Show full text]
  • The Role of the Tensor Veli Palatini Muscle in the Development of Cleft Palate-Associated Middle Ear Problems
    Clin Oral Invest DOI 10.1007/s00784-016-1828-x REVIEW The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems David S. P. Heidsieck1 & Bram J. A. Smarius1 & Karin P. Q. Oomen2 & Corstiaan C. Breugem1 Received: 8 July 2015 /Accepted: 17 April 2016 # The Author(s) 2016. This article is published with open access at Springerlink.com Abstract Conclusion More research is warranted to clarify the role of Objective Otitis media with effusion is common in infants the tensor veli palatini muscle in cleft palate-associated with an unrepaired cleft palate. Although its prevalence is Eustachian tube dysfunction and development of middle ear reduced after cleft surgery, many children continue to suffer problems. from middle ear problems during childhood. While the tensor Clinical relevance Optimized surgical management of cleft veli palatini muscle is thought to be involved in middle ear palate could potentially reduce associated middle ear ventilation, evidence about its exact anatomy, function, and problems. role in cleft palate surgery is limited. This study aimed to perform a thorough review of the lit- Keywords Cleft palate . Eustachian tube . Otitis media with erature on (1) the role of the tensor veli palatini muscle in the effusion . Tensor veli palatini muscle Eustachian tube opening and middle ear ventilation, (2) ana- tomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair. Introduction Materials and methods A literature search on the MEDLINE database was performed using a combination of the keywords Otitis media with effusion is very common in infants with an Btensor veli palatini muscle,^ BEustachian tube,^ Botitis media unrepaired cleft palate under the age of 2 years.
    [Show full text]
  • Abbreviations - Diagnosis
    Abbreviations - Diagnosis AB abrasion AT attrition CA caries CFL cleft lip CFP cleft palate CLL cervical line lesion - See TR CMO craniomandibular osteopathy DT deciduous (primary) tooth DTC dentigerous cyst E enamel E/D enamel defect E/H enamel hypocalcification or hypoplasia FB foreign body FORL feline odontoclastic resorptive lesion - See TR FX fracture (tooth or jaw) G granuloma G/B buccal granuloma (cheek chewing lesion) G/L sublingual granuloma (tongue chewing lesion) G/E/L eosinophilic granuloma - lip G/E/P eosinophilic granuloma - palate G/E/T eosinophilic granuloma - tongue GH gingival hyperplasia GR gingival recession LAC laceration LAC/B laceration buccal (cheek) LAC/L laceration lip LAC/T laceration tongue MAL malocclusion MAL/1 class 1 malocclusion (neutroclusion - normal jaw relationship, specific teeth are incorrectly positioned) MAL/2 class 2 malocclusion (mandibular distoclusion - mandible shorter than maxilla) MAL/3 class 3 malocclusion (mandibular mesioclusion - maxilla shorter than mandible) BV buccoversion (crown directed towards cheek) CXB caudal crossbite DV distoversion (crown directed away from midline of dental arch) LABV labioversion (crown directed towards lip) LV linguoversion (crown directed towards tongue) MV mesioversion (crown directed towards midline of dental arch) OB open bite RXB rostral crossbite MN mandible or mandibular MN/FX mandibular fracture MX maxilla or maxillary MX/FX maxillary fracture OM oral mass OM/AD adenocarcinoma OM/EPA acanthomatous ameloblastoma (epulis) OM/EPF fibromatous epulis
    [Show full text]
  • Lecture 2 – Bone
    Oral Histology Summary Notes Enoch Ng Lecture 2 – Bone - Protection of brain, lungs, other internal organs - Structural support for heart, lungs, and marrow - Attachment sites for muscles - Mineral reservoir for calcium (99% of body’s) and phosphorous (85% of body’s) - Trap for dangerous minerals (ex:// lead) - Transduction of sound - Endocrine organ (osteocalcin regulates insulin signaling, glucose metabolism, and fat mass) Structure - Compact/Cortical o Diaphysis of long bone, “envelope” of cuboid bones (vertebrae) o 10% porosity, 70-80% calcified (4x mass of trabecular bone) o Protective, subject to bending/torsion/compressive forces o Has Haversian system structure - Trabecular/Cancellous o Metaphysis and epiphysis of long bone, cuboid bone o 3D branching lattice formed along areas of mechanical stress o 50-90% porosity, 15-25% calcified (1/4 mass of compact bone) o High surface area high cellular activity (has marrow) o Metabolic turnover 8x greater than cortical bone o Subject to compressive forces o Trabeculae lined with endosteum (contains osteoprogenitors, osteoblasts, osteoclasts) - Woven Bone o Immature/primitive, rapidly growing . Normally – embryos, newborns, fracture calluses, metaphyseal region of bone . Abnormally – tumors, osteogenesis imperfecta, Pagetic bone o Disorganized, no uniform orientation of collagen fibers, coarse fibers, cells randomly arranged, varying mineral content, isotropic mechanical behavior (behavior the same no matter direction of applied force) - Lamellar Bone o Mature bone, remodeling of woven
    [Show full text]
  • Vestibule Lingual Frenulum Tongue Hyoid Bone Trachea (A) Soft Palate
    Mouth (oral cavity) Parotid gland Tongue Sublingual gland Salivary Submandibular glands gland Esophagus Pharynx Stomach Pancreas (Spleen) Liver Gallbladder Transverse colon Duodenum Descending colon Small Jejunum Ascending colon intestine Ileum Large Cecum intestine Sigmoid colon Rectum Appendix Anus Anal canal © 2018 Pearson Education, Inc. 1 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 2 Upper lip Gingivae Hard palate (gums) Soft palate Uvula Palatine tonsil Oropharynx Tongue (b) © 2018 Pearson Education, Inc. 3 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 4 Visceral peritoneum Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Submucosal glands Mucosa • Surface epithelium • Lamina propria • Muscle layer Submucosa Muscularis externa • Longitudinal muscle layer • Circular muscle layer Serosa (visceral peritoneum) Nerve Gland in Lumen Artery mucosa Mesentery Vein Duct oF gland Lymphoid tissue outside alimentary canal © 2018 Pearson Education, Inc. 5 Diaphragm Falciform ligament Lesser Liver omentum Spleen Pancreas Gallbladder Stomach Duodenum Visceral peritoneum Transverse colon Greater omentum Mesenteries Parietal peritoneum Small intestine Peritoneal cavity Uterus Large intestine Cecum Rectum Anus Urinary bladder (a) (b) © 2018 Pearson Education, Inc. 6 Cardia Fundus Esophagus Muscularis Serosa externa • Longitudinal layer • Circular layer • Oblique layer Body Lesser Rugae curvature of Pylorus mucosa Greater curvature Duodenum Pyloric Pyloric sphincter antrum (a) (valve) © 2018 Pearson Education, Inc. 7 Fundus Body Rugae of mucosa Pyloric Pyloric (b) sphincter antrum © 2018 Pearson Education, Inc.
    [Show full text]
  • The Articulatory System Chapter 6 Speech Science/ COMD 6305 UTD/ Callier Center William F. Katz, Ph.D
    The articulatory system Chapter 6 Speech Science/ COMD 6305 UTD/ Callier Center William F. Katz, Ph.D. STRUCTURE/FUNCTION VOCAL TRACT CLASSIFICATION OF CONSONANTS AND VOWELS MORE ON RESONANCE ACOUSTIC ANALYSIS/ SPECTROGRAMS SUPRSEGMENTALS, COARTICULATION 1 Midsagittal dissection From Kent, 1997 2 Oral Cavity 3 Oral Structures – continued • Moistened by saliva • Lined by mucosa • Saliva affected by meds 4 Tonsils • PALATINE* (laterally – seen in oral periph • LINGUAL (inf.- root of tongue) • ADENOIDS (sup.) [= pharyngeal] • Palatine, lingual tonsils are larger in children • *removed in tonsillectomy 5 Adenoid Facies • Enlargement from infection may cause problems (adenoid facies) • Can cause problems with nasal sounds or voicing • Adenoidectomy; also tonsillectomy (for palatine tonsils) 6 Adenoid faces (example) 7 Oral structures - frenulum Important component of oral periphery exam Lingual frenomy – for ankyloglossia “tongue-tie” Some doctors will snip for infants, but often will loosen by itself 8 Hard Palate Much variability in palate shape and height Very high vault 9 Teeth 10 Dentition - details Primary (deciduous, milk teeth) Secondary (permanent) n=20: n=32: ◦ 2 incisor ◦ 4 incisor ◦ 1 canine ◦ 2 canine ◦ 2 molar ◦ 4 premolar (bicuspid) Just for “fun” – baby ◦ 6 molar teeth pushing in! NOTE: x 2 for upper and lower 11 Types of malocclusion • Angle’s classification: • I, II, III • Also, individual teeth can be misaligned (e.g. labioversion) Also “Neutrocclusion/ distocclusion/mesiocclusion” 12 Dental Occlusion –continued Other terminology 13 Mandible Action • Primary movements are elevation and depression • Also…. protrusion/retraction • Lateral grinding motion 14 Muscles of Jaw Elevation Like alligators, we are much stronger at jaw elevation (closing to head) than depression 15 Jaw Muscles ELEVATORS DEPRESSORS •Temporalis ✓ •Mylohyoid ✓ •Masseter ✓ •Geniohyoid✓ •Internal (medial) Pterygoid ✓ •Anterior belly of the digastric (- Kent) •Masseter and IP part of “mandibular sling” •External (lateral) pterygoid(?)-- also protrudes and rocks side to side.
    [Show full text]
  • Basic Histology (23 Questions): Oral Histology (16 Questions
    Board Question Breakdown (Anatomic Sciences section) The Anatomic Sciences portion of part I of the Dental Board exams consists of 100 test items. They are broken up into the following distribution: Gross Anatomy (50 questions): Head - 28 questions broken down in this fashion: - Oral cavity - 6 questions - Extraoral structures - 12 questions - Osteology - 6 questions - TMJ and muscles of mastication - 4 questions Neck - 5 questions Upper Limb - 3 questions Thoracic cavity - 5 questions Abdominopelvic cavity - 2 questions Neuroanatomy (CNS, ANS +) - 7 questions Basic Histology (23 questions): Ultrastructure (cell organelles) - 4 questions Basic tissues - 4 questions Bone, cartilage & joints - 3 questions Lymphatic & circulatory systems - 3 questions Endocrine system - 2 questions Respiratory system - 1 question Gastrointestinal system - 3 questions Genitouirinary systems - (reproductive & urinary) 2 questions Integument - 1 question Oral Histology (16 questions): Tooth & supporting structures - 9 questions Soft oral tissues (including dentin) - 5 questions Temporomandibular joint - 2 questions Developmental Biology (11 questions): Osteogenesis (bone formation) - 2 questions Tooth development, eruption & movement - 4 questions General embryology - 2 questions 2 National Board Part 1: Review questions for histology/oral histology (Answers follow at the end) 1. Normally most of the circulating white blood cells are a. basophilic leukocytes b. monocytes c. lymphocytes d. eosinophilic leukocytes e. neutrophilic leukocytes 2. Blood platelets are products of a. osteoclasts b. basophils c. red blood cells d. plasma cells e. megakaryocytes 3. Bacteria are frequently ingested by a. neutrophilic leukocytes b. basophilic leukocytes c. mast cells d. small lymphocytes e. fibrocytes 4. It is believed that worn out red cells are normally destroyed in the spleen by a. neutrophils b.
    [Show full text]
  • The Myloglossus in a Human Cadaver Study: Common Or Uncommon Anatomical Structure? B
    Folia Morphol. Vol. 76, No. 1, pp. 74–81 DOI: 10.5603/FM.a2016.0044 O R I G I N A L A R T I C L E Copyright © 2017 Via Medica ISSN 0015–5659 www.fm.viamedica.pl The myloglossus in a human cadaver study: common or uncommon anatomical structure? B. Buffoli*, M. Ferrari*, F. Belotti, D. Lancini, M.A. Cocchi, M. Labanca, M. Tschabitscher, R. Rezzani, L.F. Rodella Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy [Received: 1 June 2016; Accepted: 18 July 2016] Background: Additional extrinsic muscles of the tongue are reported in literature and one of them is the myloglossus muscle (MGM). Since MGM is nowadays considered as anatomical variant, the aim of this study is to clarify some open questions by evaluating and describing the myloglossal anatomy (including both MGM and its ligamentous counterpart) during human cadaver dissections. Materials and methods: Twenty-one regions (including masticator space, sublin- gual space and adjacent areas) were dissected and the presence and appearance of myloglossus were considered, together with its proximal and distal insertions, vascularisation and innervation. Results: The myloglossus was present in 61.9% of cases with muscular, ligamen- tous or mixed appearance and either bony or muscular insertion. Facial artery pro- vided myloglossal vascularisation in the 84.62% and lingual artery in the 15.38%; innervation was granted by the trigeminal system (buccal nerve and mylohyoid nerve), sometimes (46.15%) with hypoglossal component. Conclusions: These data suggest us to not consider myloglossus as a rare ana- tomical variant.
    [Show full text]
  • Oral-Peripheral Examination
    Oral-Peripheral Examination SCSD 632 Week 2 Phonological Disorders 3. General Cautions Relating to the Oral-Peripheral Examination a. Use your initial impressions of the child’s speech and facial characteristics to guide your examination. b. Remember that one facial or oral abnormality may be associated with others. c. If you suspect an abnormality in structure or function you may want to get a second opinion from a more experienced SLP or an SLP who specializes in craniofacial or motor-speech disorders before initiating referrals to other professionals. d. Remember that in the case of most “special” conditions, it is not your role to diagnose the condition; rather it is your responsibility to make appropriate referrals. e. Remember that in Canada you cannot usually refer directly to a specialist; be sensitive in your approach to the family doctor or referring physician. f. Be sensitive about how you present your results to parents, especially when you are recommending referrals to other professionals. The parents have the right to refuse the referral. g. An oral-peripheral examination is at least as important for your young patients as for your older patients. 1 Oral-Peripheral Examination | Oral and Facial Structure z Face z Lips z Teeth z Hard palate z Soft palate z Tongue When you perform an oral-peripheral examination what are you looking for when you examine each of the following structures? a. Facial Characteristics: overall expression and appearance, size, shape and overall symmetry of the head and facial structures b. Teeth: maxillary central incisors should extend just slightly over the mandibular central incisors; the lower canine tooth should be half-way between the upper lateral incisor and the upper canine tooth c.
    [Show full text]
  • Pharyngeal Flap
    Cincinnati Children’s Hospital Medical Center Craniofacial Center and VPI Clinic Pharyngeal Flap What is Velopharyngeal Insufficiency (VPI)? During normal speech, the soft palate (also called velum) raises and closes against the back wall of the throat (also called pharynx or pharyngeal wall). This closes off the nose from the mouth for speech. If the soft palate is not long enough to firmly close against the back of the throat during speech, sound and air can leak into the nose through the gap. This condition is called velopharyngeal insufficiency (VPI). VPI can affect resonance, which is the quality of the voice. The voice may sound hypernasal because there is too much sound in the nose during speech. (Hyponasality is the opposite problem. It is due to blockage in the nose and occurs when the person has a bad cold.) VPI can also affect speech sound production. The child may not have enough air pressure in the mouth to make certain speech sounds. Also, a leak of air through the nose may be heard during speech. To correct VPI for normal speech, the opening between the nose and mouth must be closed. The Furlow Z-plasty can correct VPI, particularly for children with a history of cleft palate or submucous cleft (where the muscles under the skin of the soft palate have not come together properly). Procedure: The pharyngeal flap is done by taking a flap of tissue from the back of the throat (pharyngeal wall) and attaching it to the soft palate (velum). This flap forms a “bridge” to close the gap between the back of the throat and the soft palate.
    [Show full text]
  • Initial Stage of Fetal Development of the Pharyngotympanic Tube Cartilage with Special Reference to Muscle Attachments to the Tube
    Original Article http://dx.doi.org/10.5115/acb.2012.45.3.185 pISSN 2093-3665 eISSN 2093-3673 Initial stage of fetal development of the pharyngotympanic tube cartilage with special reference to muscle attachments to the tube Yukio Katori1, Jose Francisco Rodríguez-Vázquez2, Samuel Verdugo-López2, Gen Murakami3, Tetsuaki Kawase4,5, Toshimitsu Kobayashi5 1Division of Otorhinolaryngology, Sendai Municipal Hospital, Sendai, Japan, 2Department of Anatomy and Embryology II, Faculty of Medicine, Complutense University, Madrid, Spain, 3Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, 4Laboratory of Rehabilitative Auditory Science, Tohoku University Graduate School of Biomedical Engineering, 5Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan Abstract: Fetal development of the cartilage of the pharyngotympanic tube (PTT) is characterized by its late start. We examined semiserial histological sections of 20 human fetuses at 14-18 weeks of gestation. As controls, we also observed sections of 5 large fetuses at around 30 weeks. At and around 14 weeks, the tubal cartilage first appeared in the posterior side of the pharyngeal opening of the PTT. The levator veli palatini muscle used a mucosal fold containing the initial cartilage for its downward path to the palate. Moreover, the cartilage is a limited hard attachment for the muscle. Therefore, the PTT and its cartilage seemed to play a critical role in early development of levator veli muscle. In contrast, the cartilage developed so that it extended laterally, along a fascia-like structure that connected with the tensor tympani muscle. This muscle appeared to exert mechanical stress on the initial cartilage.
    [Show full text]
  • Ear Pain in Patients with Oropharynx Carcinoma: Karlt.Beer Peter Vock How MRI Contributes to the Explanation Richard H
    Eur Radiol (2004) 14:2206–2211 DOI 10.1007/s00330-004-2340-2 HEAD AND NECK Harriet C. Thoeny Ear pain in patients with oropharynx carcinoma: KarlT.Beer Peter Vock how MRI contributes to the explanation Richard H. Greiner of a prognostic and predictive symptom Received: 22 October 2003 Abstract Reflex otalgia is a predic- glossus muscle, stylopharyngeus Revised: 11 March 2004 tive and prognostic parameter for lo- muscle, hyoglossus muscle and pre- Accepted: 5 April 2004 cal control in patients with orophar- epiglottic space. No difference was Published online: 1 May 2004 ynx carcinoma. Can a morphologic found for the muscles of mastication, © Springer-Verlag 2004 correlate of this important symptom levator and tensor veli palatini mus- be detected by MRI? Thirty-six pa- cles, styloglossus muscle, genioglos- tients were prospectively evaluated sus muscle, intrinsic muscles of the by MRI before radical radiotherapy. tongue, digastric muscles, mucosal Sixteen patients had reflex otalgia; surface of the lateral and posterior 20 did not. The oropharynx and adja- pharyngeal wall, uvula, valleculae, cent regions were analyzed. Alter- parapharyngeal space and larynx. An ation was defined as effacement of alteration of structures innervated by H. C. Thoeny (✉) · P. Vock anatomical structures, signal alter- the glossopharyngeal nerve was vi- Department of Diagnostic Radiology, ation or enhancement after contrast sualized on MRI significantly more Inselspital, χ2 University of Bern, medium administration. The -test often when reflex otalgia was pres- Freiburgstrasse 10, 3010 Bern, Switzerland was used to compare categorical pa- ent. Involvement of structures inner- e-mail: [email protected], rameters. In patients with reflex vated by other cranial nerves did not [email protected] otalgia, alteration of the following show the same association with ear Tel.: +41-31-6322939 structures innervated by the glosso- pain.
    [Show full text]