Types Of Soft Palate Research Articles

Morphological Varieties of Soft Palate in Normal Individuals, Cleft Palate Patients and Obstructive Sleep Apnea Patients with Reference to Indian Population: A Preliminary Digital Cephalometric Study

ABSTRACT Objective To identify the morphological varieties of the soft palate on a digital lateral cephalogram in the median sagittal plane which is presented variously in normal individuals with age and gender and also to assess if there exists any morphological variations in the soft palate among cleft palate and obstructive sleep apnea (OSA) groups. Materials and methods A total of 120 normal subjects, 15 cleft palate patients and 15 OSA patients, whose ages ranged from 5 years and above were included. The morphology of the soft palate on lateral cephalometry was examined and classified into different types. The dimensional differences of the soft palate between the types and the differences in proportion to different age and gender groups were also studied in normal individuals, cleft palate patients and OSA patients. Results The morphology of the soft palate was classified into six types with an additional ungrouped type. There was a significant increase in the length of soft palate with age. In cleft palate patients, the predominant type of soft palate was type 3 with shorter velar length, while the predominant type of soft palate in OSA patients was type 1 with the length of the soft palate longer than that of the normal group. No significant difference was observed between males and females with respect to the mean length in normal group, cleft palate group and OSA group. Conclusion Soft palate presents variable radiographic appearances on lateral cephalometry. The classic velar morphology in cleft palate and OSA patients serves as an alternative modality of investigation to identify the etiology at an earlier stage. How to cite this article Deepa V, David CM, Ramnarayan BK. Morphological Varieties of Soft Palate in Normal Individuals, Cleft Palate Patients and Obstructive Sleep Apnea Patients with Reference to Indian Population: A Preliminary Digital Cephalometric Study. World J Dent 2013;4(4):241-249.

Diverse Morphologies of Soft Palate in Normal Individuals: A Cephalometric Perspective

Purpose: Soft palate plays a significant role in various important functions in the head and neck region. Its varied morphology is implicated in variety of diseases. Therefore, it is essential to establish the morphology of soft palate in normal patients to establish the variations in its morphology in various diseases. The present study aims to investigate the variation of the soft palate morphology in Indian subpopulation and possibly classify types of soft palate, to evaluate the dimensional differences of the soft palate between each types and to investigate the proportional differences in different age and gender groups. Materials and methods: Two hundred digital lateral cephalograms were analyzed for the velar morphology and categorized into different types. In addition length and thickness of the soft palate was also measured. Results: In addition to original seven types of soft palate two more morphological variants of soft palate were observed. The velar length was significantly higher in males and the velar width was significantly less in females. Also a significant increase in velar length was observed with increase in age. Conclusion: Type 1 was the most common of all the variants. Moreover, additional morphological variants which did not fit into the classical categories were also observed. There was no significant correlation between the different age groups and the types of soft palate. The velar length and width was significantly greater in males than in females. A significant increase in velar length was noted with increase in age.

A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants.

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome.

A Fiberscopic Analysis of Velopharyngeal Movement before and after Primary Palatoplasty in Cleft Palate Infants

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our Findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome. (Plast. Reconstr. Surg. 102: 668, 1998.)

Acoustic Analysis of Snoring and the Site of Airway Obstruction in Sleep Related Respiratory Disorders

Seventy-five adult patients with sleep related respiratory disorders were examined by polysomnography with simultaneous recordings of the intraluminal pressure of the upper airway and snoring sound. Obstructed sites in the upper airway during sleep were determined by comparing the amplitude of respiratory fluctuation of the pressures in the epipharynx, mesopharynx, hypopharynx and esophagus. A definite correlation existed between the intensity of snoring sound and the amplitude of respiratory fluctuation of the intraesophageal pressure. Based on the results of the intraluminal pressure partitioning, the subjects were divided into the soft palate type (28), the tonsil/tongue base type (14), the combined type (27) and the larynx type (6). The average value of fundamental frequency (ff) was 102.8 - 34.9 Hz in the soft palate type, 331.7 - 144.8 Hz in the tonsil/tongue base type, 115.7 - 58.9 Hz in the combined type and around 250 Hz in the larynx type.

閉塞型睡眠時無呼吸症における閉塞部位診断 薬物睡眠下内視鏡検査を用いて

Objective: 55 patients diagnosed as having obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The effects of surgery were studied based on the findings of endoscopic examination under drug-induced sleep and AHI measurements performed before and after the operation. Changes in airway form during sleep were observed, and the usefulness of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was studied.Methods: The site of airway obstruction during sleep induced by intravenous injection of 10mg of diazepam was classified into five types, and changes in AHI and the site of airway obstruction were compared before and after surgery.Results: The postoperative improvement rate was 73.5% in the soft palate type of obstruction, 75.6% in the tonsillar type, 52.3% in the full-circumference palatal type and 32.3% in the mixed type. Surgical treatment by UPPP had an excellent or good effect on the soft palate and tonsillar types. However, many patients with the ful1-circumference palatal type and the mixed type showed less improvement compared with the soft palate and tonsillar type.Conclusion: In the full-circumference palatal type and the mixed type, improvement can be expected following operations which include surgical treatment of the posterior pharyngeal wall or the lateral funiculus, or midline laser glossectomy.

閉塞性睡眠時呼吸障害の閉塞部位診断

Obstructive sleep respiratory disorders (OSRD) are breathing disorders occuring during sleep, which include snoring and sleep apnea syndromes.Twenty-two adult patients who had been diagnosed as having OSRD underwent polysomnographic examination with two point baroreceptors, one in the esophageal area and the other in the mesopharyngeal area. We could find the site of obstruction by simultaneous two point pressure measurements. There were four types of OSRD: the transfer type (Group A, n=1), root-of-tongue type (Group B, n=5), combined type (Group C, n=3) and soft-palate type (Group D, n=14).The mean followed by that in the intraesophageal pressure (EP) was highest in the root-of-tongue type. The combined type was higher that in the soft-palate type. Apnea index was greatest in combined type than followed by that in the soft-palate type. The decrease of SaO2 then in the root-of-tongue type and combined type patients were the most obese.The correct diagnosis of the area of obstruction and the selection of the operative method most appropriate for that area are very important.

Structure of hamster palatal gingiva and intermolar mucosa after intraperitoneal dosing with N-methyl-N-nitrosourea: a scanning electron microscope study

The palatal gingiva and intermolar mucosa from normal hamsters and from hamsters that had received N-methyl-N-nitrosourea (NMU) intraperitoneally were examined by scanning electron microscopy over a 22-week period. The normal gingiva and rostral two-thirds of the intermolar mucosa were covered by flat polygonal cells that had a regular honeycomb surface pattern of interconnecting micro-ridges, distinct cell boundaries and imprints of cells that had been desquamated. The caudal third of the intermolar mucosa in normal and NMU-treated hamsters was covered by soft-palate type mucosa whose smooth surfaced cells surrounded scattered fungiform-like papillae. In NMU-treated hamsters changes were more common in the rostral two-thirds of the intermolar mucosa than in the gingiva. At 10 weeks there were sessile and conical surface projections and saucer-shaped and conical epithelial-lined depressions. At 16 weeks these projections and depressions were larger and more numerous, and groups of conical projections formed papillomatous-like lesions. At 22 weeks the projections and depressions were further increased in number and size and there were distinct papillomas. At 10 and 16 weeks the entire epithelium showed cells, cell boundaries and cell imprints resembling those in the controls, except that there were defects or dilated intercellular spaces at the base of the conical depressions and some of the cells were thicker. Much of the 22-week epithelial had a similar structure, but in some areas that did not show the projections or depressions the cells varied in size and shape and were covered by elongated micro-ridges. Here the surface was irregular as were the cell boundaries. Examination of sections by light microscopy, both from these irregular areas and from areas that appeared normal by scanning electron microscopy, revealed that the deeper epithelial strata could be either normal, dysplastic or at times malignant. However, scanning electron microscopy failed to reveal dysplastic or malignant epithelium.

Diurnal sleep study for sleep related breathing disorders--the utility of nasendoscopic diurnal polysomnography using diazepam

Twenty two patients with obstructive sleep apnea syndrome were examined by nocturnal polysomnography (n-PSG), and the obstructive sites in the upper airway were observed by nasendoscopic diurnal polysomnography using diazepam (n-d-PSGD). The types of apnea were divided into three groups according to the obstructive sites in the upper airway: soft palate apnea, tongue base apnea, and combined type apnea. Among the 22 patients, there were 17 soft palate apneas, 3 tongue base apneas and 2 combined type apneas. All patients underwent uvulopalatopharyngoplasty (UPPP). Preoperative values of AI, AR, DI and mean sleep SaO2 were 37.2, 24.5%, 31.4 and 92.5%, and the postoperative values were 10.4, 7.3%, 6.8 and 94.8%, respectively. Criteria were established to define UPPP responders, as follows: 50% or more reduction in AI and postoperative AI less than 20. The overall improvement rate was 81.0%. The improvement rates for soft palate apnea, combined type apnea and tongue base apnea were 93.8%, 50.0%, and 0%, respectively. In 15 of the 22 patients, measurements of mesopharyngeal and esophageal pressures were performed simultaneously with n-d-PSGD. In these 15 patients, 12 soft palate apneas, 2 combined type apneas and 3 tongue base apneas were observed with n-d-PSGD, while 7 soft palate apneas, 3 combined type apneas and 5 tongue base apneas were detected by measuring the pressures. The results of these two methods concurred in only nine of fifteen patients. It was suspected that the obstructive sites in the upper airway were identified by tissues with n-d-PSGD, but by region with the pressure measuring method. It was suggested that UPPP is the most suitable treatment for patients with soft palate type apnea, without pathologic obesity. n-d-PSGD is a useful method of evaluating respiratory status during sleep, can be performed in a few hours, and can simultaneously identify the obstructive site in the upper airway, so as to allow treatment planning.