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Head and Neck Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Warrenkevin Henderson, Hannah Jacobson, Noelle Purcell, Kylar Wiltz
Senoo et al. (2001) describe a case of congenital unilateral soft palate aplasia in which palatoglossus and levator veli palatini were absent on the right side. In a fetus with craniorachischisis, palatoglossus was the only soft palate/pharyngeal muscle that was present (Alghamdi et al. 2017). Bersu et al. (1976) describe a male infant with Hanhart syndrome. On the right side of this infant, the muscles of the soft palate were underdeveloped and displaced. A muscle descended from the cartilage of the auditory tube and split into two portions at the level of the soft palate. The anterior portion of this muscle inserted onto the side of the tongue forming the right palatoglossal arch. The posterior portion blended with the superior pharyngeal constrictor and the stylopharyngeus muscles forming the palatopharyngeal arch. In an otocephalic fetus examined by Lawrence and Bersu (1984), muscle fibers were present in the soft palate, but most individual palatal muscles could not be identified. In a male neonate with Meckel syndrome, Pettersen (1984) found that palatoglossus and palatopharyngeus originated from the medial aspect of the medial pterygoid plate on each side, instead of originating from the soft palate.
History Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
The palatine tonsils form part of Waldeyer’s ring of lymphoid tissue in the pharynx along with the adenoid pad, lingual tonsils and mucosa-associated lymphoid tissue (MALT). They sit within the tonsillar fossa, bordered anteriorly by the palatoglossal arch (anterior pillar) and posteriorly by the palatopharyngeal arch (posterior pillar). Acute tonsillitis involves inflammation of the palatine tonsillar tissue and is extremely common in the United Kingdom, especially in the paediatric population; and contributes to missed days of school and work every year. There are other causes of ‘sore throats’ that are worth bearing in mind including viral upper respiratory tract infections, pharyngitis, and in the adult population, Candida, gastro-oesophageal reflux and malignancy. The history is vital for both diagnosis and importantly establishing frequency of episodes and the impact on the child in context, e.g. looming GCSEs. In the exam setting it is important to remember the potential ‘hidden agenda’ that could be held by the parents, in this case arranging a tonsillectomy for their child. Acute tonsillitis can be viral or bacterial in origin, with group A beta-haemolytic streptococcus being the most common organism. Glandular fever, secondary to Epstein–Barr virus, can present similarly to acute bacterial tonsillitis, with a typically longer history of symptoms. There are other viral causes including adenovirus and respiratory syncytial virus which may be complicated by superadded bacterial infection.
Anatomy of the Pharynx and Oesophagus
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Palatopharyngeus is as much a pharyngeal muscle as it is a muscle of the soft palate. It has two heads and thus two actions. While both heads lie in the same plane, they are separated by levator veli palatini, a soft palate muscle. Its thicker anterior head originates from the posterior border of the hard palate and the anterior and superior surfaces of the palatine aponeurosis respectively. Its posterior head also originates from the superior surface of the palatine aponeurosis, but from further back on it. These two heads fuse at the lateral border of the palatine aponeurosis, are joined by fibres of salpingopharyngeus and arch downwards from here to insert into the posterior border of the thyroid lamina alongside stylopharyngeus and salpingopharyngeus. As it makes its way down as a single muscle covered in submucosa and mucosa, it forms the posterior faucial pillar, or palatopharyngeal arch. This muscle has a dual purpose: it elevates the larynx and pharynx and constricts the palatopharyngeal arch to assist in swallowing and, additionally, enables the concave shape of the oral surface of the palate with its arch.
Total versus subtotal tonsillectomy for recurrent tonsillitis – a prospective randomized noninferiority clinical trial
Published in Acta Oto-Laryngologica, 2020
Ulrich Kisser, Claudia Lill, Christine Adderson-Kisser, Martin Patscheider, Klaus Stelter
SIPT was performed using the CelonLab ENT/CelonProCut system (Celon/Olympus, Olympus Surgical Technologies Europe) at a power setting of 15 W. Cold dissection TE was performed on the other side. Pressure with sterile cotton balls on the wound bed for several minutes and defined bipolar electrocautery of small vessels were used for hemostasis on both sides. At the end of the procedure 3 mL of Bupivacain were injected into the mucosa of the palatoglossal and palatopharyngeal arches on each side for postoperative pain reduction [9,10]. Patients were hospitalized for six days postoperatively and treated with pain medication according to the WHO guidelines. During that time they were asked to record pain on each side using visual analogue scales (0–10) four times a day at defined time points.
Role of Smoking-Mediated molecular events in the genesis of oral cancers
Published in Toxicology Mechanisms and Methods, 2019
The teeth and gums positioning partition oral cavity into two major sections: oral vestibule and oral cavity proper (Gray 1918). Orifice of mouth opens into oral vestibule followed by oral cavity proper. The oral vestibule is a narrow slit-like space enclosed by buccal mucosa of cheeks & lips, teeth stacks and the gingival wall (gums). The oral cavity proper is the space constituting of maxillary (upper) and mandibular (lower) dental alveolar arches, hard palate, soft palate, 2/3rd anterior tongue, and floor of the mouth. When upper and lower teeth stacks are in contact, the oral vestibule and oral cavity proper communicate through gaps between last molars and ramus of the mandible (Gray 1918; NCI 2018). Oral cavity and oropharynx are continuous through oropharyngeal isthmus (Melo et al. 2018). Tonsillar fossa-pillars forms the base and start for oral cavity and oropharynx respectively (Batsakis 2003; Chen and Chao 2012). The tonsillar fossa is a triangular region bordered by an anterior-posterior tonsillar pillar (palatoglossal-palatopharyngeal arches) and occupied by the palatine tonsil (Gray 1918). The intra-oral surfaces are covered with less keratinized, more pinkish non-masticatory and thin mucosa; while the exceptional subsites of the hard palate, dorsal surface of the tongue, and gingiva are covered with highly keratinized, pale masticatory and firm-stippled mucosa covers (Dadgostar 2015). The oral mucosal tissue comprises of epithelial layers (stratified squamous cells) as the outermost part (facing the oral cavity) followed by basement membrane (basal lamina), and lower connective tissue lamina propria (loose irregular connective tissue); beneath oral mucosa lies submucosal layer (dense irregular connective tissue) (Squier and Kremer 2001; Hamdoon 2013; Cruchley and Bergmeier 2018).
Mandibular advancement splints for the treatment of obstructive sleep apnea
Published in Expert Review of Respiratory Medicine, 2020
Andrew S. L. Chan, Kate Sutherland, Peter A. Cistulli
OSA is increasingly being recognized as a heterogeneous disorder with multiple pathophysiological causes, both anatomical and non-anatomical. By targeting OSA treatment to specific underlying pathophysiological mechanisms, it may be possible to broaden treatment options and improve clinical outcomes [8]. It has been traditionally thought that the primary mechanism of action of MAS is to cause mechanical advancement of the mandible and thereby increase the antero-posterior dimensions of the oropharynx. However, the specific biomechanical changes that underlie the efficacy of these devices are unknown, although there is some evidence from upper airway imaging studies that mandibular advancement improves the patency of the velopharyngeal segment of the upper airway, the most common site of upper airway collapse and flow limitation in OSA [9,10], with the lateral diameter of the velopharynx increasing to a greater extent than the antero-posterior diameter [7,11,12]. The precise reason for this effect on velopharyngeal patency is unclear. However, soft tissue connections exist between the mandible, tongue, lateral pharyngeal walls and soft palate, within the palatoglossal and palatopharyngeal arches. It has been proposed that such soft tissue connections may be stretched by mandibular advancement [13] and this has been confirmed using dynamic tagged magnetic resonance imaging, with the soft tissue connections appearing to correspond to the region of the pterygomandibular raphe [14]. These structural changes are associated with a dose-dependent reduction in the collapsibility of the upper airway, as measured by a reduction of the upper airway closing pressure during sleep [15] and a reduction in upper airway critical closing pressure (Pcrit) [16], both of which reflect the passive mechanical properties of the upper airway. While some research studies have shown that mandibular advancement stimulates genioglossus muscle activity [17,18], others have found that it reduces genioglossus muscle activity [19,20], and the clinical importance of upper airway neuromuscular reflexes in the mechanism of action of MAS remains uncertain [16]. Research studies have shown that using oral appliances that do not provide mandibular advancement have no significant clinical benefit for the treatment of OSA, suggesting that such a mechanism plays a minor role [21,22]. Thus, mandibular advancement primarily modifies the ‘anatomical imbalance’ as a contributing factor in OSA [8] which can vary in importance depending on ethnicity and gender [23,24]. There is no evidence that MAS have a direct impact on other non-anatomical factors, such as arousal threshold or loop gain [25]. The mechanism of action of MAS is schematically illustrated in Figure 1, with axial magnetic resonance images showing an increase in the caliber of the upper airway.