Abstract
ObjectiveOtitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited.This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair.Materials and methodsA literature search on the MEDLINE database was performed using a combination of the keywords “tensor veli palatini muscle,” “Eustachian tube,” “otitis media with effusion,” and “cleft palate.”ResultsSeveral studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tube’s dilatation mechanism.ConclusionMore research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems.Clinical relevanceOptimized surgical management of cleft palate could potentially reduce associated middle ear problems.
Highlights
Otitis media with effusion is very common in infants with an unrepaired cleft palate under the age of 2 years
Its prevalence is reduced after surgical cleft palate repair, a significant number of children continue to suffer from middle ear disease throughout their child- and adulthood [3, 4]
Optimal otological management in cleft palate patients has historically been a point of discussion, with ventilation tubes often being inserted preventively at the time of cleft palate repair
Summary
Otitis media with effusion is very common in infants with an unrepaired cleft palate under the age of 2 years. At the time of cleft palate repair, more than 90 % of the middle ears contain mucoid material (Bglue ear^) [1, 2]. Its prevalence is reduced after surgical cleft palate repair, a significant number of children continue to suffer from middle ear disease throughout their child- and adulthood [3, 4]. During the learning phase of these infants, hearing loss can have a significant negative effect on their development of speech, language, and (social) behavior [4, 5, 7]. Optimal otological management in cleft palate patients has historically been a point of discussion, with ventilation tubes often being inserted preventively at the time of cleft palate repair. Routine ventilation tube insertion leads to short-term hearing gain, the long-term otological outcome of these patients does not appear to be superior to outcomes of patients receiving ventilation tubes merely on indication [8, 9]
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