Muscle spindles in the human levator veli palatini and palatoglossus muscles

Muscle spindles are present in many muscles of the speech mechanism including those of the jaw, tongue, larynx, and respiratory system. Past investigations that have examined muscles of the velopharynx for the presence of muscle spindles have reported their existence only in the tensor veli palatini and palatoglossus muscles. The present investigation has demonstrated the existence of muscle spindles in two muscles of the human velopharynx--the levator veli palatini (LVP) and palatoglossus muscles. Seven LVP and two palatoglossus muscles were embedded in paraffin blocks, serially sectioned at 8 microns, and selected slides were stained by a modified Gomori trichrome technique. Scanning by light microscopy at 40x revealed spindles in all of the muscles examined. This positive finding likely reflects the use of a more chromatically distinctive staining procedure and a higher scanning magnification than were used in prior investigations. The potential roles of muscle spindles in velopharyngeal function are addressed.     

Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.     

Motor innervation of the eustachian tube muscles in the guinea pig

The brainstem location of motoneurons innervating eustachian tube-associated muscles in the adult guinea pig was determined using intramuscular injections of the neural tracer horseradish peroxidase (HRP). Following HRP injections into the tensor veli palatini and the eustachian tube belly of the medial pterygoid muscle, an ipsilateral column of HRP-labeled motoneurons was present medial to the dorsolateral division of the trigeminal motor nucleus. Following HRP injection into the levator veli palatini, labeled motoneurons were present in the ipsilateral dorsal division of nucleus ambiguus. The locations of the tensor veli palatini and levator veli palatini motoneurons are similar to those found in studies of other animals. A distinct eustachian tube belly of the medial pterygoid muscle was also identified. This sub-belly had a motoneuron pool distinct from the main medial pterygoid muscle group. The authors have provided the gross anatomical and neuroanatomical substrates upon which future studies of eustachian tube function in the guinea pig may be based.     

Localization of motoneurons innervating the Eustachian tube muscles in cat

The localizations of the motoneurons supplying the tensor tympani muscle (TTM), tensor veli palatini muscle (TVPM) and levator veli palatini muscle (LVPM) were determined by retrograde transport of horseradish peroxidase (HRP) in the cat. TTM motoneurons were found ipsilaterally outside the trigeminal motor nucleus in an area just ventral to it. TVPM motoneurons were distributed mainly in the ventral part of the ipsilateral trigeminal motor nucleus. They were more compactly distributed in the rostral part of the nucleus than in the caudal part. LVPM motoneurons were found in the ipsilateral nucleus ambiguus. There were no HRP-labelled cells in the contralateral nucleus ambiguus.     

阻塞性睡眠呼吸暂停低通气综合征腭帆张肌病理形态学研究

目的 通过研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者腭帆张肌病理形态学改变,探讨腭帆张肌病理变化与失神经支配的关系。方法 经PSG检查确诊OSAHS患者30例,通过HE、Masson、胆碱脂酶（AchE）染色及透射电镜进行腭帆张肌形态学观察和图像分析,并与10例慢性扁桃体炎患者作比较。结果 OSAHS患者腭帆张肌的病理变化为肌纤维细胞萎缩,截面积减少,胶原纤维细胞增加,胶原纤维截面积增加,肌肉截面积/胶原截面积比率下降;肌纤维结构紊乱,肌丝溶解,部分Z线呈锯齿状排列,甚至消失,肌原纤维排列紊乱,肌浆网扩张,线粒体聚集,有髓鞘神经纤维水肿,髓鞘部分松解,鞘膜断裂呈葱皮样改变,出现裂隙,见大量异常颗粒沉积;运动终板数量明显减少甚至消失。结论 OSAHS患者腭帆张肌中运动终板及周围神经发生了明显形态学变化,病变程度与肌肉病理变化呈正相关,OSAHS的发生发展可能与腭帆张肌失神经支配有关。     

The effect of tensor veli palatini stimulation on upper airway patency.

OBJECTIVE: To evaluate the effect of selective electrical stimulation of the tensor veli palatini muscle on upper airway patency. METHODS: Pressure-flow relationships were evaluated, in a feline isolated upper airway preparation, to determine the role of the soft palate musculature on airflow dynamics. The tensor veli palatini muscles were selectively stimulated while monitoring upper airway collapsibility (critical pressure), maximal inspiratory airflow, and the nasal resistance upstream to the flow-limiting site. RESULTS: Tensor veli palatini stimulation resulted (mean +/- SEM) in an increase in maximal inspiratory airflow from 74 +/- 13 mL/s to 93 +/- 18 mL/s (P= .04). The increase in maximal inspiratory airflow was associated with a decrease in critical pressure from -2.3 +/- 1.7 cm H2O to -4.7 +/- 2.7 cm H2O (P= .01) and an increase in nasal resistance from 32.4 +/- 24.3 cm H2O x L(-1) s(-1) to 50.8 +/- 29.7 cm H2O x L(-1) s(-1) (P= .02). CONCLUSIONS: Tensor veli palatini stimulation decreases upper airway collapsibility and is likely an integral component in maintaining airway patency. However, the effects of the isolated tensor veli palatini muscles are less significant than those seen previously with physiologic stimuli such as hypercapnia. These findings suggest that upper airway patency, although contributed to by the tensor veli palatini, requires the coordinated activation of palatopharyngeal muscles to adequately influence upper airway collapsibility.     

Muscular compliance of the auditory tube]

BACKGROUND: The simultaneous electromyographical assessment of innervation patterns of the mylohyoid and the tensor veli palatini muscle is introduced as a new technique for the examination of the auditory tube function. PATIENTS AND METHODS: Clinical studies were performed on 30 healthy volunteers and 50 patients suffering from chronic tubotympanic mucositis and cholesteatoma. Concentric needle electrodes were advanced into the tensor veli palatini muscle through the palate. The mylohyoid muscle was examined using surface electrodes. RESULTS: Innervation patterns of the tensor veli palatini muscle in volunteers were limited to the time interval of the mylohyoid innervation pattern only, i.e., the oral and pharyngeal phases of swallowing. In 14 of the chronic otitis patients these tensor muscle innervation patterns were found outside this interval. CONCLUSION: This observation provides a new pathophysiological explanation for the clinical concept of a relative closing failure of the auditory tube. These results emphasize the significance of coordination in muscular compliance of the tube.     

咽鼓管薄层断面与磁共振成像对照研究

目的研究咽鼓管和毗邻结构的断面形态及相互解剖关系,为临床影像学诊断提供解剖学依据.方法利用生物塑化技术,将9侧咽鼓管区及相邻结构制成三个平面(横断、冠状位及矢状位)的薄层断层标本,并与磁共振成像(MRI)对照,观察咽鼓管及毗邻结构在各方位的走行与解剖关系.结果在横断、冠状断面上可较好显示咽鼓管的正常解剖结构及毗邻关系,咽鼓管纤维软骨位于咽鼓管后内侧,其上缘向外弯曲形成软骨部的顶.咽鼓管咽筋膜封闭咽鼓管前外侧并向下延伸构成咽鼓管的下壁.腭帆张肌位于咽鼓管前外侧,腭帆提肌位于其外后下方.粘膜下筋膜位于腭帆提肌的内侧,咽颅底筋膜走行于腭帆张肌和腭帆提肌之间,Weber-Liel筋膜位于腭帆张肌外侧.结论MRI可较好显示咽鼓管软骨部及其肌肉、筋膜;应用塑化薄层断面可直接与MRI扫描图像进行对照研究,对鼻咽区病变的影像诊断具有重要参考价值.     

A new aspect on the development of chronic middle ear diseases in patients with cleft palate

BACKGROUND: The prevalence of chronic middle ear disease in patients after surgery for cleft palate is about 50%. Aim of the present study was to analyse its morphological and physiological causes to prevent chronic atelectatic otitis media or cholesteatoma. METHODS: 15 adult patients with cleft palate were examined using middle ear microscopy, pure tone audiometry, EMG of the tensor veli palatini muscle and MRI of the Eustachian tube. RESULTS: 8 of 15 patients had chronic middle ear disease. With 13 of 15 patients single motor unit action potentials could be recorded from the tensor veli palatini muscle. MRI of the Eustachian tube revealed two decisive observations in patients with chronic middle ear disease: in 4 patients the pterygoid hamulus could not be detected, in all otitis patients the continuity of tensor veli palatini muscle was interrupted or disturbed by medial or lateral fixation. CONCLUSION: Chronic middle ear disease with cleft palate patients is basically caused by impaired muscular compliance of the Eustachian tube. Thus integrity of hamulus as well as tensor veli palatini muscle must become of crucial interest in cleft palate surgery.     

阻塞性睡眠呼吸暂停低通气综合征腭帆张肌失神经变化

目的通过研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者腭帆张肌中钙蛋白酶-1（calpain 1）和神经细胞黏附分子（neural cell adhesion molecule,NCAM）的表达以及运动终板形态改变,探讨OSAHS患者上气道扩张肌失神经变化。方法选取30例OSAHS患者作为实验组,10例排除OSAHS的慢性扁桃体炎患者作为对照组。通过乙酰胆碱脂酶（acetylchelin esterase,AchE）染色法显示运动终板形态变化,免疫组化Elivison二步法检测腭帆张肌中calpain 1和NCAM的表达。结果①OSAHS组运动终板数量明显减少甚至消失：②calpain-1和NCAM的表达水平明显高于对照组,差异有显著性意义（P〈0．05）;③calpain1和NCAM的表达水平均与呼吸紊乱指数呈正相关（r=0．811,P=O．000：r=0．692,P=0．000）。结论OSAHS患者上气道扩张肌存在失神经支配病变,且病情越重失神经的程度也越严重。     

阻塞性睡眠呼吸暂停低通气综合征上气道开大肌凋亡现象研究

目的:观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者腭帆张肌中Bax、Bcl-2的表达水平,探讨OSAHS患者上气道开大肌肌纤维是否存在凋亡现象。方法:选取30例OSAHS患者作为实验组,10例已排除OSAHS的慢性扁桃体炎患者作为对照组。采用免疫组织化学Elivison二步法和计算机图像分析系统检测两组腭帆张肌中Bax、Bcl-2的表达水平并进行对比分析。结果:①实验组Bax的表达水平和Bax/Bcl-2的比值明显高于对照组,差异有统计学意义(P<0.05);②Bax的表达水平与呼吸紊乱指数呈正相关(r=0.697,P<0.01)。结论:OSAHS患者上气道开大肌存在凋亡现象,且病情越重凋亡的程度也越严重。     

Three-dimensional computer graphics of the eustachian tube

Images of the eustachian tube from various directions were obtained using computer graphics. Serial cross sections of a human temporal bone specimen including the eustachian tube were digitized for reconstruction. Wire-frame models of the structures such as the eustachian tube lumen, the tubal cartilage, the tensor veli palatini muscle, and the levator veli palatini muscle were drawn. Through observation of the eustachian tube from various directions with the tubal muscles attached or detached, the physiology of the eustachian tube system could be understood more clearly.     

鼻咽癌初诊患者中耳功能的相关多因素量化分析

目的：探索量化和客观评价鼻咽癌初诊患者的中耳功能的方法,采用多因素及量化的方法分析其影响因素。方法：对320例（320耳）鼻咽癌初诊患者行电耳镜、声导抗检测、纯音听阈测试、鼻咽部及中耳CT或MRI扫描、咽鼓管功能检查、电子鼻咽镜检查,量化评估中耳功能;采用SPSS13．0进行单因素及多因素分析。结果：T分期、临床分期、肿物部位、扩散类型、形态、咽鼓管功能及咽口形态、影像学侵犯范围（鼻腔、颅底、咽隐窝、咽旁间隙、腭帆张肌、腭帆提肌）是影响鼻咽癌初诊患者的中耳功能单因素,而性别、年龄、病理类型、N分期、M分期对鼻咽癌初诊患者中耳功能无影响;多因素分析显示：T分期、肿物部位、咽鼓管功能、腭帆张肌侵犯、颅底侵犯是影响鼻咽癌初诊患者中耳功能的独立因素。结论：鼻咽癌初诊患者的中耳功能受T分期、肿物部位、咽鼓管功能、腭帆张肌侵犯、颅底侵犯等相关因素影响,本研究探讨的中耳量化标准能较为客观地评估鼻咽癌初诊患者的中耳功能。     

Objective tinnitus caused by myoclonus of the musculus tensor veli palitini

Objective tinnitus is often caused by palatal myoclonus. We report a 15 years old boy with objective tinnitus in both ears and palatal myoclonus. He had myorhythmic movements of both tensor veli palatini muscles asynchronous with the objective tinnitus. The frequency of the clonus was 120 contractions a minute. The myoclonus and the objective tinnitus disappeared after division of the bilateral tensor veli palatini muscles.     

Clinical applications of pharyngeal electroneurography

Electroneurography of soft palate, Eustachian tube and pharynx was carried out in 60 normal adults and 187 patients. This test was performed on the 2-channel Schwarzer 2,000 electromyograph. The 2 cm long concentric needle electrodes were used for recording and were inserted into muscles of glossopalatinus, pharyngopalatinus, tensor veli palatini and levator veli palatini. Four cm long stimulating electrodes were used to stimulate the mandibular branch of trigeminal nerve and pharyngeal branch of vagus nerve. Stimuli of 100 voltage were delivered as rectangular pulses of 0.1-0.2 ms duration at a rate of 1-2 Hz. In normal subjects, the latency of the evoked wave induced from tensor veli palatini by stimulating the mandibular branch of trigeminal nerve was 1.8 +/- 0.6 ms. The latency of the evoked wave induced from levator veli palatini, glossopalatinus, pharyngopalatinus were 1.9 +/- 0.6, 2.0 +/- 0.4, 1.9 +/- 0.7 ms respectively. In 35 patients with paralysis of soft palate and pharynx, no evoked potential could be recorded in 18 cases, meaning complete nerve injury, latency delayed in 10 cases, indicating partial nerve injury, normal latency of evoked potential in 7 cases. One hundred and twenty-four cases of otitis media, 20 cases of myoclonus of soft palate and pharynx and 8 cases of cleft palate were also studied. Their electrogroms were normal. This technique may be used not only to measure nerve conductivity directly but also to make correct diagnosis of neuromuscular disorders of these structures without serious complications.     

Eustachian tube-Tensor veli palatini muscle-cranial base relationships in children and adults: An osteological study

Objective

The vector relationships between the Eustachian tube, Tensor veli palatini muscle and cranial base constrain the efficiency of middle ear pressure-regulation and are required parameters for computational modeling of Eustachian tube function. Here, those relationships were reconstructed from skulls and compared between children and adults.

Method

Reconstructions were made using modifications of previously described techniques for 18 child skulls aged 3-4 years and 20 adult skulls (10 females, 10 males; >18 years). Measured and calculated variables were compared between groups using a Student's t-test.

Results

Consistent with previous reports, certain variables for adult skulls exhibited sexual dimorphism. Between children and adults, significant differences were documented for measures of cranial base length and width; hard palate width; nasopharyngeal height, width and depth; Eustachian tube length; the maximum and minimum Tensor veli palatini muscle lengths; the angles of deviation of the Tensor veli palatini muscle from the Eustachian tube, and the surface area of the Tensor veli palatini muscle. There were no between-group differences in the angle of Eustachian tube decent from the cranial base, Eustachian tube deviation from the parasagittal plane or the lateral component of the Tensor veli palatine muscle-Eustachian tube angle.

Conclusions

The differences between children and adults that could account for the observed poorer Eustachian tube function in children include their shorter Eustachian tube, lesser Tensor veli palatine muscle-Eustachian tube vectors, and the lesser Tensor veli palatine muscle surface area. Other observed differences are attributable to growth and development of the craniofacial complex.     

Age-related morphologic differences in the components of the eustachian tube/middle ear system

The current study utilized a three-dimensional computer graphics technique to analyze the size, shape, and positional associations of the eustachian tube (ET) cartilage and lumen, the levator veli palatini (LVP) muscle, and the tensor veli palatini (TVP) muscle. Older specimens 7 years and above (n = 13) were compared to young specimens less than 7 years (n = 4). Our results suggest that changes in ET function associated with age could result from size and shape differences in the ET cartilage and changes in the position of the LVP and TVP muscles.     

Magnetic resonance imaging of the eustachian tube. A correlative anatomical study

Magnetic resonance (MR) imaging of the eustachian tube (auditory tube) was performed in normal subjects and in a patient with nasopharyngeal carcinoma. The MR images obtained in an anteriorly tilted transaxial plane parallel to the eustachian tubes were compared with serial slices of a cadaver specimen. The eustachian tube cartilage, mucous lining of the eustachian tube, the lateral pharyngeal recess, the tensor veli palatini muscle, and the levator veli palatini muscle were identified in MR images using anatomical relationships. A patient with nasopharyngeal carcinoma is described to demonstrate an example of topographical morbid changes appearing around the eustachian tube.     

The extended bundle of the tensor veli palatini: Anatomic consideration of the dilating mechanism of the Eustachian tube

Objective

The aim of this study was to analyze the topographical structures of the muscles surrounding the Eustachian tube.

Clinical study of otological manifestations in cases of cleft palate

Cleft palate (with or without cleft lip) occurs in about 1: 750–1: 2000 births in different societies in the world. Cleft palate individuals have a greater incidence of hearing loss than the general population. The primary cause of the ear problem in cleft patients is eustachian tube dysfunction. The cause for which is abnormal insertion of levator veli palatini and tensor veli palatini muscles into the posterior margin of the hard palate and the palatal aponeurosis and associated muscular hypoplasia.