Palatal Anatomy Research Articles

Evaluating the Impact of Different Education Methods on Cleft Lip and Palate Anatomy Training.

To compare the effects of different educational methods on short and long-term learning outcomes and to investigate the satisfaction and perception of cleft lip and palate (CLP) education among dental students. The theoretical exam on CLP to determine their baseline level of knowledge was taken by the participants(T0). After the exam, the students were randomly divided into three groups and all students attended a lecture-based traditional education on CLP. Students in the first group (n = 40) received no additional teaching (Group A). Students in the second group (n = 38) received model teaching with 3D-printed models (Group B). The third group (n = 39) was trained in e-learning-supported education (Group C). The theoretical exam was repeated immediately after the education (T1/short-term learning), one week later (T2/early long-term learning), and one month later (T3/late long-term learning), and the effect of the education methods on information level was assessed. In addition, a post-training satisfaction questionnaire was administered to participants of Group B and Group C. Both 3D model-based and e-learning-supported approaches significantly improved immediate knowledge of CLP. However, no significant differences were found in knowledge retention over time between the all methods. A majority of students favored the incorporation of both methods in orthodontic education. While both 3D models and e-learning effectively enhance short-term CLP knowledge among dental students, their long-term educational impacts are comparable. However, student preferences indicated that the use of 3D-printed models and e-learning strategies may be useful augmentations to traditional lecture education.

Determination of the Frequency of Various Anatomical Forms of the Hard Palate for Complete Denture Fabrication

OBJECTIVE: To determine the frequency of patients with various anatomical forms of the hard palate for complete denture fabrication and to compare the mean distortion in heat cure denture base polymer in millimetres in different hard palate forms. METHODOLOGY: Informed consent was taken from total of seventy six patients and divided into low and medium hard palate forms. Dental casts were prepared from alginate impression and poured in type III stone and reference point R was marked on the deepest part of the posterior palatal seal area at the junction of hard and soft palate on each cast. After curing, the cast along with the cured denture base was retrieved from the flask. After 48h of curing cycle the distortion was measured in millimetres from R to R' via traveling microscope. RESULTS: Among seventy six participants the frequency of low palate forms was 45 (59.2%) and medium palate forms was 31 (40.8%). For each sample three readings were taken R1, R2 and R3. The mean distortion measured in low hard palate form was 0.52mm with a standard deviation of 0.18, the mean distortion measured in medium hard palate form was 0.76mm with a standard deviation of 0.27, which were clinically significant with a p-value of 0.0001. CONCLUSION: The hard palate forms has direct influence on retention of maxillary complete denture in posterior palatal area. KEY WORDS: Heat Cure denture base, distortion in hard palate forms, dimensional changes in heat cure, hard palate anatomy and denture bases

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

The choanal anatomy of theSebecus icaeorhinusSimpson, 1937 and the variation of the palatine shape in notosuchians (Crocodyliformes, Mesoeucrocodylia)

AbstractSebecidae is a clade of large carnivorous crocodyliforms that thrived in the Cenozoic and is the only lineage of the diverse and terrestrial group Notosuchia that survived the end-Cretaceous mass extinction event.Sebecus icaeorhinusis the best-known taxon from this clade, both in terms of its cranial and postcranial anatomy (known primarily from the holotype and specimen MPEF-PV 1776, respectively). Additional material represented by a partial skull (MMP 235) is the only specimen that has preserved a complete choanal region. We describe new information from this specimen based on an X-ray computed tomography and identify through comparisons with other taxa a large degree of variability in the palatal anatomy within Sebecidae, in particular in the shape and extension of the palatine (the bone that defines the anterior position and shape of the secondary choana). We quantify variation in the shape of the palatine bone of sebecids through a 2D morphogeometric analysis within the context of notosuchian crocodyliforms. Although traditional accounts of palatal evolution in crocodyliforms linked variation of this structure to the adaptation to the aquatic environment, our analysis allows recognition of eight palatine morphotypes among terrestrial crocodyliforms with very distinct paleoecological traits, including carnivorous, omnivorous, and possibly herbivorous taxa. Furthermore, we show that sebecids had a higher morphological disparity in the choanal region than other terrestrial groups of Notosuchia, underscoring the importance of this region for comparative, morphofunctional, and phylogenetic studies.

The Morphological Variation of the Soft Palate in Hospital Visiting Patients.

The soft palate anatomy of individuals can have a range of morphologies. Cephalometric analysis is a low-cost approach to analyze the soft palate in patients with or without developmental abnormalities. The lateral cephalogram of the patients visiting Tribhuvan University Teaching Hospital, Institute of Medicine for various dental treatment purposes was evaluated. The soft palate was delineated on the radiographs by sketching the soft palate's contour along its radiolucent outline using the curve lines and connectors of Microsoft PowerPoint. The soft palate was then categorized according to the study by You M et al. Results: The different types of soft palate morphology observed in the study were rat tail (42.4%), leaf-like (40.8%), butt-like shape (8.9%), straight-line (4.7%), s-shaped (1.9%), and crooked (0.9%). The males had rat-tail (44.4%), leaf-like (41.1%), butt-like shape (8.4%), straight-line (3.9%), s-shaped (1.3%), and crooked (0.6%), whereas the females had rat-tail like (40.6%), leaf-like (40.6%), butt-like shape (9.5%), straight-line (5.6%), s-shaped (2.5%), and crooked (1.2%) types of soft palate. The rat-tail form of the soft palate was the most prevalent, followed by the leaf-like in both sexes. The least common type was the crooked form. This study found no evidence of sexual dimorphism.

Palate evolution in early-branching crocodylomorphs: Implications for homology, systematics, and ecomorphology.

Living crocodylomorphs have an ossified secondary palate with a posteriorly positioned choana that enables their semi‐aquatic, predatory ecology. In contrast, the earliest branching members of Crocodylomorpha have an open palate with anteriorly positioned choanae. The evolution of an ossified secondary palate and a posteriorly positioned choana features strongly in hypotheses of broad‐scale phylogenetic relationships within Crocodylomorpha. Renewed investigations into palatal morphology among extinct members of the clade show surprising variability in the anatomy of the palate, with at least one and potentially a second independent occurrence of “eusuchian‐type” palate outside of Eusuchia. Understanding the trajectory of crocodylomorph palatal evolution is, therefore, a key to inferring crocodylomorph interrelationships and ecomorphology. To document early‐branching crocodylomorph palatal anatomy, we developed an anatomical comparative dataset using computed tomography scan data and literature, comprising 12 early‐branching crocodylomorph taxa. To understand discrete phenotypic changes in palatal structure, we compiled a phylogenetically broadly sampled character‐taxon matrix from the existing literature, and revised its palatal characters, adding 10 new palatal characters. Our comparative anatomical investigations allow us to propose an adapted hypothesis for the closure of the palate and the posterior migration of the choana. Our phylogenetic findings corroborate previous research showing that non‐crocodyliform crocodylomorphs (“sphenosuchians”) are paraphyletic, with the exclusion of the clade Hallopodidae. Non‐mesoeucrocodylian crocodyliforms (“protosuchians”) are paraphyletic, but form three monophyletic clades: Notochampsoidea, Shartegosuchoidea, and Gobiosuchidae. We find a potential association between secondary palate development and dietary shifts, particularly with regard to hypothesized origins of herbivory.

Patterns of secondary palate convergence across Amniota

Living amniotes (mammals, birds, and ‘reptiles’) display a tremendous disparity in craniofacial form and composition, reflecting over 300 million years of evolutionary divergence. The anatomical specialization and ecological diversification of amniotes makes it relatively trivial to distinguish a modern mammal skull from a bird or a turtle from a crocodylian. Despite the anatomical divergences, the roof of the mouth reveals remarkable similarities across these major clades. In fact, mammals, crocodylians, and some lizards have independently derived “secondary palates” which divide the nasal and oral passages (to greater or lessor degrees). However, this conspicuous example of convergent evolution has yet to be characterized in a quantitative analysis. Several critical questions therefore remain poorly understood, including: how convergently similar are “secondary palates”? and are there multiple evolutionary pathways to achieve a “secondary palate”? To begin to address these questions, we captured palate shape using two‐dimensional geometric morphometrics from representatives of all extant amniote clades, including all lineages which have been described as possessing “secondary palates”, and key representatives from the fossil record. This landmarking approach allowed for quantifying both the overall shape of the palate but also the key connections among palate elements. These data demonstrate that crocodylians and mammals possess remarkably similar palate anatomy, principally due to the presence of extensive palatal shelves on the maxilla and mid‐line contact of the palatines. Other reptiles with putative “secondary palates” do not overlap with crocodylians but rather cluster with other lizards and turtles. There is much greater diversity in palate form observed among squamates, likely reflecting greater functional and/or ecological utility of the palate than in other amniote clades. Extant birds occupy a distinct region of morphospace, potentially reflecting the enlargement of the premaxillary component of the palate. The inclusion of extinct forms reveals that living clades possess substantially modified and derived palate forms compared with ancestral amniotes, regardless of whether they possess “secondary palates” or not. However, several key elements including the ectopterygoid and vomer could not be landmarked due to their absence or exclusion from the ventral surface of the palate in key taxa. There are important differences in the structure and function of the nasal passage among amniote clades, necessitating consideration of other ossified and unossified components when discussing the degree of convergence in palate form and potential explanatory factors. Incorporating the full three‐dimensional anatomy of the palate will allow the inclusion of these additional elements and may reveal important nuance to the patterns recovered in this analysis. Future analyses capturing the full volumetric form of individual elements and the entire palate, using a combination of fixed and pseudo landmarks, will be conducted to assess the strength of the patterns recovered here.

New Ankylosaurian Cranial Remains From the Lower Cretaceous (Upper Albian) Toolebuc Formation of Queensland, Australia

Australian dinosaur research has undergone a renaissance in the last 10 years, with growing knowledge of mid-Cretaceous assemblages revealing an endemic high-paleolatitude Gondwanan fauna. One of its most conspicuous members is ankylosaurs, which are rare but nonetheless occur in most Australian dinosaur-bearing formations spanning the uppermost Barremian to lower Cenomanian. Here we describe a partial ankylosaur skull from the marine Toolebuc Formation exposed near Boulia in western Queensland, Australia. This skull represents the oldest ankylosaurian material from Queensland, predating the holotype of Kunbarrasaurus ieversi, which was found in the overlying Allaru Mudstone. The ankylosaur skull is encased in a limestone concretion with the maxillary tooth rows preserved only as impressions. Synchrotron radiation X-ray tomography was used to non-destructively image and reconstruct the specimen in 3D and facilitate virtual preparation of the separate cranial bones. The reconstruction of the skull revealed the vomer, palatines, sections of the ectopterygoids and maxillae, and multiple teeth. The palate has posteriorly positioned choanae that differs from the more anterior placement seen in most other ankylosaurians, but which is shared with K. ieversi, Akainacephalus johnsoni, Cedarpelta bilbeyhallorum, Gobisaurus domoculus, and Panoplosaurus mirus. Phylogenetic analyses place the new cranial material within the recently named basal ankylosaurian clade Parankylosauria together with K. ieversi. This result, together with the anatomical similarities to the holotype of K. ieversi, permits its referral to cf. Kunbarrasaurus sp. This specimen elucidates the palatal anatomy of Australian ankylosaurs and highlights one of the most ubiquitous components of Australian mid-Cretaceous dinosaur faunas.

Modeling Skull Network Integrity at the Dawn of Amniote Diversification With Considerations on Functional Morphology and Fossil Jaw Muscle Reconstructions

One of the major questions in evolutionary vertebrate morphology is the origin and meaning of temporal skull openings in land vertebrates. Partly or fully surrounded by bones, one, two, or even three openings may evolve behind the orbit, within the ancestrally fully roofed anapsid (scutal) skull. At least ten different morphotypes can be distinguished in tetrapods with many modifications and transitions in more crownward representatives. A number of potential factors driving the emergence and differentiation of temporal openings have been proposed in the literature, but only today are proper analytical tools available to conduct traceable tests for the functional morphology underlying temporal skull constructions. In the present study, we examined the anatomical network in the skull of one representative of early amniotes, †Captorhinus aguti, which ancestrally exhibits an anapsid skull. The resulting skull modularity revealed a complex partitioning of the temporal region indicating, in its intersections, the candidate positions for potential infratemporal openings. The framework of †C. agutiwas then taken as a template to model a series of potential temporal skull morphotypes in order to understand how skull openings might influence the modular composition of the amniote skull in general. We show that the original pattern of skull modularity (†C. aguti) experiences comprehensive changes by introducing one or two temporal openings in different combinations and in different places. The resulting modules in each skull model are interpreted in regard to the feeding behavior of amniotes that exhibit(ed) the respective skull morphotypes. An important finding is the alternative incorporation of the jugal and palate to different modules enforcing the importance of an integrated view on skull evolution: the temporal region cannot be understood without considering palatal anatomy. Finally, we discuss how to better reconstruct relative jaw muscle compositions in fossils by considering the modularity of the skull network. These considerations might be relevant for future biomechanical studies on skull evolution.

Palatal mucosa thickness and palatal neurovascular bundle position evaluation by cone-beam computed tomography-retrospective study on relationships with palatal vault anatomy.

BackgroundMeasuring the thickness of the palatal mucosa at the planning of the surgical procedure is an important step in order to obtain the maximum width and thickness of the graft from the appropriate area. The aim of this study is to determine whether there is a relationship between palatal angle (PA) or palatal depth (PD) and palatal mucosa thickness (PMT) or palatal neurovascular bundle distance (PNBD).MethodsPMT, PNBD, PD and PA were measured on cone-beam computed tomography (CBCT) images of maxillary posterior region of 200 male and 200 female patients. The mean of all parameters according to gender was compared and the significance of the difference detected between groups was evaluated. Potential relationship between PMT or PNBD and PA or PD was also evaluated.ResultsIn females, the palatal mucosa was significantly thinner at all tooth regions (p < 0.005), and PNBD was lower only at the level of the second molar (p < 0.001). In addition, it was found that there was a significant inverse correlation between the palatal depth value and the palatal mucosal thickness, and palatal depth was correlated with the palatal neurovascular bundle distance (p ≤ 0.001).DiscussionConsistent with previous studies, it was observed that the thickest mucosa in the palatal region was located in the region of the premolar teeth, and women had thinner palatal mucosa. In addition, in patients with a deeper palate vault, the palatal mucosa was thinner, but the palatal neurovascular bundle was more distant from the cemento-enamel junction.

Phonetic contouring of polished surface of denture base for speech enhancement

The three main factors in complete denture construction are mechanics, esthetics, and phonetics. Out of which phonetics is generally given least importance as the tongue tends to adapt and patients tend to return to normal speech after a post insertion practice period of several weeks to several months. This may not be acceptable to certain group of people in accordance with their needs to speak socially or vocationally. An accurate approximation of palatal contours of a maxillary complete denture to patient’s tongue can improve intelligibility and decrease the post- insertion practice period. This article outlines a technique to replicate the patient’s palatal anatomy onto the polished palatal surface of a complete denture.

The anatomy of the palate in Early Triassic Chaohusaurus brevifemoralis (Reptilia: Ichthyosauriformes) based on digital reconstruction.

The palatal anatomy of ichthyosauriforms remains largely unknown. Here, the complete palate of the early-branching ichthyosauriform Chaohusaurus brevifemoralis is reconstructed and described for the first time with the assistance of high-resolution X-ray computed tomography (CT) scanning on the basis of the three-dimensionally preserved skull of its paratype (GMPKU-P-3086) from the Lower Triassic of South China. The reconstruction reveals new palatal features of C. brevifemoralis. The palatine contacts the jugal directly, which is observed in ichthyosauriforms for the first time. A single row of denticles is present on each side of the palate. The vomer exceeds the anterior and posterior margins of the internal naris. The pterygoid is posterior to the internal naris. The epipterygoid is present and the ectopterygoid is absent.

Stress distribution and displacement of three different types of micro-implant assisted rapid maxillary expansion (MARME): a three-dimensional finite element study

Background/objectiveUntil 2010, adults underwent surgical treatment for maxillary expansion; however, with the advent of micro-implant-assisted rapid maxillary expansion (MARME), the availability of less invasive treatment options has increased. Nevertheless, individuals with severe transverse maxillary deficiency do not benefit from this therapy. This has aroused interest in creating a new device that allows the benefit of maxillary expansion for these individuals. The aim of this study was to evaluate the efficacy of three MARME models according to tension points, force distribution, and areas of concentration in the craniofacial complex when transverse forces are applied using finite element analysis.Materials and methodsDigital modeling of the three MARME models was performed. Model A comprised five components: one body screw expander and four adjustable arms with rings for mini-implant insertion. These arms have an individualized height adjustment that allows MARME positioning according to the patient’s palatal anatomy, thereby preventing body screw expander collision with the lateral mucosa in severe cases of maxillary deficiency. Model B was a maxillary expander with screw rings joined to the body, and model C was similar to model B, except that model C had open rings for the insertion of the mini-implants. Through the MEF (Ansys software), the stresses, distribution, and area of concentration of the stresses were evaluated when transverse forces of 7.85 N were applied.ResultsThe three models maintained the following pattern: model C presented weak stress peaks with limited distribution and lower concentration area, model B obtained median stress peaks with better distribution when compared to that of model C, and model A showed better stress distribution and larger concentration area. In model A, tensions were located in the lateral lamina of the pterygoid process, which is an important site for maxillary expansion. The limitation of the present study was that it did not include the periodontal tissues and muscles in the finite element method evaluation.ConclusionsModel A showed the best stress distribution conditions. In cases of severe atresia, model A seems to be an excellent option.

Palatal Anatomy and Phenotypes for the Treatment of OSA

Palatal Anatomy and Phenotypes for the Treatment of OSA

Is there a correlation between skull base flexure and palatal anomalies in patients with 22q11 deletion syndrome and velopharyngeal dysfunction?

The study aimed at assessing the relationship between skull base morphology, represented by skull base and nasopharyngeal angles, and palatal anatomy among patients with 22q11DS and velopharyngeal dysfunction.Retrospective analysis of patients with 22q11DS and velopharyngeal dysfunction. Age, sex, severity of velopharyngeal dysfunction, type of cleft (overt cleft palate, submucous cleft palate, occult submucous cleft palate, or no-CP, and cephalometric skull base angles were reviewed. Correlations between type of palatal anomaly and the angles were assessed.Among 132 patients, 71 were male (53.8%) and 61 were female (46.2%), ages 3.3–40.0 years (mean 8.3 ± 6.10). No difference in the mean cranial-base angle (P = 0.353) or in the distribution of the three types of cranial base angle sizes was found among the palatal anomaly groups (P = 0.137). More men had normal cranial base angles and more women had acute angulation (P = 0.008). A positive correlation was found between the skull base and nasopharyngeal angles (P = 0.001, r = −0.590).No direct correlation was found between cranial base morphology and palatal anomalies in patients with 22q11DS, and velopharyngeal dysfunction. This is probably because skull base and palate morphology contribute independently to velopharyngeal dysfunction.

Assessment of Functional Recovery and Subjective Donor-Site Morbidity Following Radial Forearm Flap Reconstruction in Small- to Moderate-Sized Palatal Defects.

Palatal defects are encountered following tumor extirpation, trauma, or congenitally. Among the known alternatives, radial artery free forearm flap (RAFF) is a versatile flap that confers good results in head and neck reconstruction, but donor-site morbidity has been an issue of discontent among the plastic surgeons. This limitation needs to be studied further and addressed considering the unmatched quality of this tissue. This study aims to weigh the impact of the functional edge of this flap against the unpopular donor-site morbidity on a group of patients. This is a retrospective analysis of recuperation of palatal function and patient concerns with the donor-site function and cosmesis on 7 consecutive patients with small-to-moderate palatal defects reconstructed with RAFF. Postoperative recovery of speech, palatal movement, and restoration of oromaxillary interface was assessed using objective tests, such as speech intelligibility testing and articulation studies. Simultaneously, subjective donor-site function and cosmesis were assessed using Patient Scar Assessment Scale (PSAS), Upper Extremity Functional Index (UEFI), and donor limb sensory testing. Mean PSAS score was 8.28/60, and UEFI score reported was 77/80, which reflect high patient satisfaction with the donor site. Nasoendoscopy shows remarkable restoration of palate anatomy. Intelligibility testing depicts near-normal speech understandability, whereas articulation studies revealed distortions post-palatal reconstruction with RAFF. Radial artery free forearm flap should be considered as the forerunner of reconstruction in palatal defects involving less than 50%.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial

IntroductionThe association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. ObjectiveThis prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1±1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. ResultsRapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0–T1, T1–T2, T0–T2, and T0–T3 observation periods (p<0.05). The significant increase was observed in right middle ear volumes during the T0–T1, T0–T2 and T0–T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p<0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. ConclusionCorrection of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

A Review of and Algorithmic Approach to Soft Palate Reconstruction.

The soft palate contributes to deglutition, articulation, and respiration. Current reconstructive techniques focus on restoration of both form and function. The unique challenges of soft palate reconstruction include maintenance of complex upper aerodigestive tract function, with minimal local or donor site morbidity. To review the literature on soft palate reconstruction and present an algorithm on how to approach soft palate defects based on this review. A review of the literature for articles reporting studies on and that described concepts related to soft palate reconstruction was conducted in March 2017. In all, 1804 candidate titles and abstracts were independently reviewed. English-language articles that discussed acquired soft palate defect reconstruction were included. Non-English language studies without available translations, studies on primary soft palate defect reconstruction (ie, cleft palate repair) and primary cleft palate repair, studies in which the soft palate was not the focus of the article, and studies involving animals were excluded. The following observations were made from the review of 92 included articles. Soft palate anatomy is a complex interplay of multiple structures working in a 3-dimensional area. Three of the authors created an initial algorithmic framework based on the selected studies. After this, a round table discussion among 3 authors considered experts was used to refine the algorithm based on their expert opinion. The 4 most important factors were determined to be defect size, defect extension to other subsites, defect thickness, and history of radiotherapy or planned radiotherapy. This algorithm includes both surgical and nonsurgical options. Defects in the soft palate not only affect the size and shape of the organ but, more critically, the function. The reconstructive ladder is used to help maximize the remaining soft palate functional tissue and minimize the effect of nonfunctional implanted tissue. Partial-thickness defects or defects less than one-fourth of the soft palate may not require locoregional tissue transfer. Patients with a history of radiotherapy or defects of up to 75% of the soft palate may require locoregional tissue transfer. Defects greater than 75% of the soft palate, defects that include exposure of the neck vasculature, or defects that include significant portions of the hard palate or adjacent oropharyngeal subsites may require free tissue transfer. Obturation should be considered a second-line option in most cases. Ideal reconstruction of the soft palate relies on a comprehensive understanding of soft palate anatomy, a full consideration of the armamentarium of surgical techniques, consideration for adjacent subsite deficits, and a detailed knowledge of various intrinsic and extrinsic patient factors to optimize speech, swallowing, and airway outcomes. The included algorithm may serve as a useful starting point for the surgeon when considering reconstruction.

Morphology of the Musculus Uvulae In Vivo Using MRI and 3D Modeling Among Adults With Normal Anatomy and Preliminary Comparisons to Cleft Palate Anatomy.

To investigate the musculus uvulae morphology in vivo in adults with normal velopharyngeal anatomy and to examine sex and race effects on the muscle morphology. We also sought to provide a preliminary comparison of musculus uvulae morphology in adults with normal velopharyngeal anatomy to adults with repaired cleft palate. Three-dimensional magnetic resonance imaging data and Amira 5.5 Visualization Modeling software were used to evaluate the musculus uvulae in 70 participants without cleft palate and 6 participants with cleft palate. Muscle length, thickness, width, and volume were compared among participant groups. Analysis of covariance analysis did not yield statistically significant differences in musculus uvulae length, thickness, width, or volume by race or sex among participants without cleft palate when the effect of body size was accounted for. Two-sample t test revealed that the musculus uvulae in participants with repaired cleft palate is significantly shorter (P = .008, 13.65 mm vs 16.07 mm) and has less volume (P = .002, 51.08 mm3 vs 97.62 mm3) than participants without cleft palate. In adults with normal velopharyngeal anatomy, the musculus uvulae is a cylindrical oblong-shaped muscle lying on the nasal surface of the soft palate, with its greatest bulk located just nasal to the levator veli palatini muscle sling. In participants with repaired cleft palate, the musculus uvulae is substantially reduced in volume. This diminished muscle bulk located just at the point where the palate contacts the posterior pharyngeal wall may contribute to velopharyngeal insufficiency in children with repaired cleft palate.

Palatal anatomy for sleep apnea surgery.

The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra‐tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures.Level of EvidenceN/A