ANATOMY OF THE PALATE BONY SKELETON BONY SKELETAL SCAFFOLD FOR THE PALATE CONSISTS OF THE BONES THE AND ADJACENT TO THE BASE OF THE SKULL INCLUDING SPHENOID THE MAXILLA AND THE TEMPORAL THE PREMAXILLA PROPER PALATINE MUSCLES BONE THESE BONES OFFER THE ORIGINS AND INSERTIONS OF THE THE AND PROVIDE THE EXITS OF THE NERVES AND BLOOD VESSELS SERVING PALATE INCISIVE FORAMEN INCISIVE SUTURE PREMAXILLA MEDIAN PALATINE UTU1E OF IN PROCESS TRANSVEISC PILINE TOMMEN LATERAL PTERYGOTD NY MEDIAL PRERYGOID F7 EUSRACHIAN INCISIVE OOVE GVA THESE BONES OF COURSE ARE COVERED WITH PERIOSTEUM BEFORE RECEIVING THE PALATAL MUSCLES AND APONEUROSIS THE ENTIRE AREA IS PALATE COVERED FINALLY WITH MUCOUS MEMBRANE IN THE HARD PALATE AREA THE MUCOSA IS GRAYISH PINK AND TIGHTLY ADHERENT TO THE PERIOS 19 SOFT TEUM THE MUCOUS MEMBRANE OF THE ORAL SURFACE OF THE VASCULAR AND RED IN COLOR COVERED BY NON PALATE IS HIGHLY OF ELASTIC KERATINIZED STRATIFIED SQUAMOUS EPITHELIUM LAYER WHICH THE LAMINA FROM THE SUBMUCOSA FIBERS SEPARATES PROPRIA AT THE FREE BORDER OF THE SOFT CONTAINS MANY MUCOUS GLANDS TO CILIATED PALATE THE ORAL MUCOSA CHANGES PSEUDOSTRATIFIED NASAL COLUMNAR EPITHELIUM OF MUCOSA PALATAL MU SCULATU RE WHO GUSTAVO SANVENEROROSSELLI OF MILAN HISTORICAL SCHOLAR REMINDED CLEFT ACCUMULATED AN EXTENSIVE PLASTIC SURGERY LIBRARY PALATE THE 1973 INTERNATIONAL CLEFT SPECIALISTS AT COPENHAGEN DA VINCI UNDERSTOOD THE FUNCTION OF THE CONGRESS THAT LEONARDO OF THE IN VOWELS IN AND WAS COGNIZANT SOFT PALATE USING SPEECH ATTAINED THE VARYING LEVELS BY PALATE DURING SPEECH OF NORMAL OF THE FIRST TRUE ANATOMICAL DESCRIPTIONS ANATOMY WERE VON LUSCHKA IN PALATE AND PHARYNX PUBLISHED BY VON LUSCHKA GERMAN IN 1868 HIS PA1AT VICTOR VEAU OF 1H DES ENFANTS ASSIST PARIS PUBLISHED LPOFLCUROSLS IN HERE HE DESCRIBED THE CLASSIC BOOK DIVISION PALATINE 1931 PA1ATOPHAI NGCUS OF CLEFT FROM HIS VAST TOMY AND PATHOLOGY PALATE GLEANED PA1ATOPHARYNGCU IN AN NUMBER OF CASES AND HIS HUNDREDS OF SURGICAL PROCEDURES OF THE HE COMPARED THE NORMAL EXPLICIT DIAGRAM PALATAL ANATOMY MUSCULATURE WITH THAT IN CLEFT SHOWING APONEUROSIS AND PALATE ONE OF HIS SOME OF THE DISPLACEMENT AND MISDIRECTION OF FIBERS IN WAS THE METALLIC SUTURE IMPORTANT CONTRIBUTIONS PALATE SURGERY OF THE MUSCLES OF THE CLEFT VEAU USED IN GATHERING THE FIBERS DISPLACED EACH OTHER EDGES PARALLEL TO IN 1930 ANATOMIST JAMES WHILLIS OF GUYS HOSPITAL LONDON INSERTED SHOWED THAT SOME FIBERS OF THE SUPERIOR CONSTRICTOR WERE AND CONSTITUTED LAMELLA HE REFERRED INTO THE PALATAL APONEUROSIS IT IS IN THE TO AS THE PALATOPHARYNGEAL SPHINCTER POSSIBLE JAME WHILIS LAMELLA THE LATERAL NORMAL PALATE THAT WHILLIS MAY NARROW PHA OBTAIN ULTIMATE OCCLUSION OF RYNGEAL RECESS THUS HELPING PALATAL THE NASOPHARYNX DURING CONTRACTURE OF THE LEVATOR BROWNE SUPERIOR CONSTRICTOR IN THE DECEMBER BRITISH A4EDZCAL THE ECCENTRIC LEVAROR 1935 JOURNAL PALATO PALARINI CONSTRICTOR INNOVATIVE DENIS BROWNE OF THE FOR SICK CHILDREN HOSPITAL PHARYNGEAL WALL GREAT ORMONDSTREET LONDON POSTULATED AN ORTHOPEDIC OPERA TION FOR CLEFT PALATE JUSTIFYING HIS DESIGN BY HIS EVALUATION OF THE CLOSURE HE MUSCULAR ACTIVITY DURING NASOPHARYNGEAL DIAGRAMED AND TWO OVERLAPPING MUSCLE SLINGS INVOLVING THE LEVATOR PALARINI AND NOTED THE OF THIS THE SUPERIOR CONSTRICTOR EFFICIENCY SPHINC TERIC ACTION WHICH AVOIDS THE NECESSITY FOR THE LARGE AMOUNT OF CONTRACTION REQUIRED BY SIMPLE SINGLE MUSCLE RING SPHINCTER 0CFIELD IN 1941 MICHAEL OLDFIELD OF THE GENERAL INFIRMARY AT LEEDS ENGLAND NOTED THAT THE MUSCULAR ELEMENTS OF THE SOFT PALATE FROM THE UVULAR CONSIST OF FOUR APART MUSCLE ESSENTIALLY SLINGS THESE ARE ACTUALLY BILATERAL MUSCLES WHICH EFFECT THE SLINGLIKE FUNCTION THROUGH THEIR COMMON INSERTION INTO THE TISSUES OF THE LEVATOR AND SOFT PALATE SUPERIORLY THESE MUSCLES ARE THE TENSOR AND PALATINI INFERIORLY THEY ARE THE PALATOGLOSSUS PALATOPHARYN GEUS ALICHAD 0AFIELD LEXAROR SUPERIOR BU PALAROPH 21 BRAITHWAITE FENTON BRAITHWAITE OF NEWCASTLE UPON TYNE RECEIVED HIS MASTERS IN MATHEMATICS AT CAMBRIDGE PRIOR TO HIS STUDY OF MEDICINE AND TRAINING WITH MCLNDOE AT EAST GRINSTEAD HE COLLECTED SUCH EXQUISITE ANTIQUES THAT IT HAS BETN SAID HIS FURNITURE WAS EITHER BACK FROM JUST COMING OR JUST GOING OFF ON LOAN TO THE VICTORIA AND ALBERT MUSEUM BRAITHWAITE WAS THE FIRST TO REALIZE THE IMPORTANCE OF CORRECTING THE MALPOSITION OF THE LEVATOR MUSCLE IN CLEFT PALATE SURGERY AT THE CLEFT PALATE 1964 CONGRESS IN HAMBURG BRAITHWAIRE NOTED OF THE FOUR MUSCULAR SLINGS OF OLDFIELD THE LEVATOR DESCENDING ON EACH SIDE AND PASSING DOWNWARDSAND FORWARDS AND THE PALAROPHARYNGEUS PASSING UPWARDS AND FORWARDS ARE MORE INTIMATELY CONCERNED WITH SPEECH HE PRESENTED DIAGRAM OF THE ANTERIOR VIEW OF THE NORMAL LEVATOR AND LOWER UPPER PALATOPHARYNGEUS MUSCLE SLINGS HEAVY AND LINE THE SUPERIOR CONSTRICTOR FINE LINE FROM ITS ATTACHMENTS AT THE BASE OF THE SKULL TO THE HAMULUS AND PTERYGOMANDIBULAR RAPHE HE EXPLAINED THE LEVAROR SLING ELEVATES THE SOFT PALATE IN BACKWARD AND UPWARDDIRECTION WHILST THE PALAROPHARYNGEAL SLINGS ON CONTRACTION WILL APPROXIMATE THE FAUCIAL AND POSRERIOT PILLARS NARROW THE PHARYNGEAL APERTURE WHEN THESE TWO SLINGS ACT TOGETHER EACH LOOP WILL AFFORD COUNTER PURCHASE FOR THE OTHER AND THE INTERPOSED PALARI STEADIED BY SIMULTANEOUS CONTRACTION WILL CONVERT EACH GROUP INTO AND THE WHOLE MECHANISM PARTAKES OF THE FEATURES OF AN AS SUGGESTED BY PODVINEC 1952 THIS WHEN MECHANISM IS EXAMINED FROM AN ANTERIOR VIEW THROUGH THE OPEN MOUTH IT MAY BE SEEN THAT AN ISTHMUS IS PRODUCED AT THE LEVEL OF THE SOFT PALATE BY PULLING IN THE LATERAL WALLS OF THE PHARYNX JR IS OBVIOUS THAT IF THEREFORE THE SLINGS ARE NOR INTACT OR INDEED IF THE SOFT PALATE IS SCARRED THIS WILL NOR BE EFFECTED AS EARLY AS 1949 BRAITHWAITE ADVOCATED CONSTRUCTING THE LEVA TOR MUSCLE SLING 22 KRIENS MAXILLOFACIAL OTTO KRIENS OF PLASTIC AND ENERGETIC PROFESSOR BREMEN GENERAL HOSPITAL GERMANY STARTED HIS TRAINING SURGERY IN 1963 UNDER KARL SCHUCHARDT IN HAM IN CLEFT LIP AND PALATE COMMANDO FOR COMBAT BECAUSE HIS BURG THIS WAS LIKE TRAINING STUDENTS HAD BE TO TEACHER WAS TASKMASTER WHOSE TO STRONG HIS SURVIVE ONCE HEARD SANVENEROROSSELLI REFER AFFECTIONATELY TO KRIENS FRIEND SCHUCHARDT AS FIIHRER THE PRESSURE PUSHED AND THIS IS WHAT HE WROTE TO OTTO KRZENS INTO THE STUDY OF PALATAL ANATOMY ME IN 1973 OF THE THERE WAS WHEN STARTED TO STUDY THE ANATOMY PALATE ASTOHISHINGLY THE CLEFT VELUM THE FIRST ABOUT HARDLY ANY LITERATURE ON ALTHOUGH REPORTS THE FIRST DETAILED ANATOMIC VELOPLASTIES DATE BACK PRIOR TO 1820 DESCRIPTIONS LUSCHKA IN OF THE NORMAL ANATOMY OF THE PALATE AND PHARYNX WERE GIVEN BY HAD BE WITHOUT KNOWL 1864 THUS THE BEGINNING OF CLEFT PALATE SURGERY TO TO BE CORRECTED WONDER THE WERE EDGE ABOUT THE PATHOLOGY NO OPERATIONS VELAR HALVES USED MORPHOLOGICAL ONES AND IN ALL METHODS THE WERE AS ENTITIES SO TO AS ARCHITECTURAL UNITS WHICH HAD TO BC MOVCD MEDIALLY ANDOR DORSALLY ACHIEVE INTEGRITY HE VEAU HAD POSTULATED CLOSURE IN LAYERS AND BE DREW SKETCHES OF WHAT HAD SEEN DURING INTERVENTIONS BRAITHWAITE FOLLOWED VEAUS PRINCIPLE EVEN FURTHER AND DISSECTED MUSCLES APPARENTLY NOR EXACTLY KNOWING WHICH WERE WHERE TRAINED THREE THE DISSECRIONS DID ON NORMAL PALATES AND PHARYNGES MY THUS DIMENSIONAL PERCEPTION BUT DID NOT REVEAL THE ESSENTIAL PATHOLOGY WHAT PROFESSOR SCBUCHARDT WAS NOR WRONGIN TEJECRING AN ARTICLE SPECULATING WHICH SEEMED TO BE WRONG IN THE VELUM HIS DISSENT WAS NOT TOO POLITE INVITE TO PROBABLY PROMPTED PROFESSOR KARFIK TO SPONTANEOUSLY ME REVEALED CHARACTERISTIC FIND PRAGUE FOR AN ANATOMICAL STUDY 1966 WHICH WEICHEN INGS KRIENS ANAROMISCHE UNTERSUCHUNGEN AM GESPALTENEN GAUMEN CHIR PLAST RECONSIR 1967 THE NECESSARY CHANGES OF THE VELAR CLOSURE WERE ONLY TOO EVIDENT AFTER THE PATHOLOGY HAD BEEN EXPOSED TO SIGHT FROM THE HERE IS HIS 1967 DIAGRAM OF THE DISSECTED SOFT PALATE ORAL ASPECT 23 ORIFICE OF TUBE HORIZONTAL LEVATOR CUT VERTICAL CIRCULAR SALPINGOPHARYNGEUS PALATOPHARY NGEUS LONGITUDINAL CIRCULAR PALATOPHARYNGEUS BUCCOPHARYNGEUS ALSO SHOWN ARE TWO OF HIS ACTUAL DISSECTIONS WITH LABELS TOTAL BILATERAL FRESH CLEFT SPECIMEN ON THE RIGHT CAN BE SEEN THE PARS PALARINAPALAROPHARYNGEUS WITH ITS INSERTION ON THE OF THE POSTERIOR EDGE PALATINE BONE AS WELL AS THE PARS PARS PTEFLYGOPHAPYNSE WITH ITS PRERYGOPHARYNGEA INSERTION ON THE HAMULUS CONTINUING THE TO APONEUROSIS BETWEEN THESE THE BELLY OF THE LEVAROR IS VISIBLE TOTAL BILATERAL CLEFT MATERIAL FIXED FOR SOME WEEKS IN 10 FORMALIN ON THE LEFT SIDE OF THE SPECIMEN THE LEVATOR BELLY WITH ALL ITS INSERTIONS IS DISSECTED AND THE PARS PALARINA OF FREED PHARYNGEUS FROM ITS HARD PALATE INSERTION HAS BEEN TURNED LATE RALLY IN PLASTIC AND RECONSTRUCTIVE SURGERY IN 1969 KRIENS SUMMA RIZED THE PATHOLOGY OF THE CLEFT PALATE ANOMALY AS THE BASIS FOR LEVATOR PLANNING RECONSTRUCTION THE FORWARD AND TRANSVERSE DISPLACEMENT OF MUSCULAR INSERTIONS BUT THE ORIGINS ARE NORMAL THE SYNERGISTICALLY INTERWOVEN ANTERIOR PORTIONS OF THE LEVATOR VELI AND OF THE PALATI LONGITUDINAL PORTION OF THE PALATOPHARYNGEAL MUSCLE VEAUS CLEFTMUSCLE THE PALATOSALPINGEAL FASCIA FORMING FUNCTIONAL BOUNDARY BETWEEN THE CONSTRICTOR PHATYNGEAL AND PALAROPHARYNGEAL MUSCLES LEVATOR SPACE OF CLEFT PALATE 24 OF LOOSE CONNECTIVE TISSUE BETWEEN THE PALAROPHARYNGEAL THE PLANE OF BLUNT DISSECTION AND THE PALATOSALPINGEAL MUSCLE PLANE SPHINCTER IN THE VELUM PROPER HORIZONTAL TENDON THE ALTERED INSERTION OF THE HYPOPLASTIC PALATINE IN THE CLEFT OF THE TENSOR VELI PALATI NO APONEUROSIS VELUM IN THE CLEFT PALATE JOURNAL IN HIS EXPLICIT DRAWINGS PRESENTED SHOW THE NORMAL PALATE THE BASIC PATHOLOGY OF JANUARY 1970 AND