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Introduction
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
The hard palate—the anterior portion of the roof of the mouth—is formed by the maxillae and palatine bones, is covered by mucous membrane, and forms a bony partition between the oral and nasal cavities. The soft palate, which forms the posterior portion of the roof of the mouth, is an arch-shaped muscular partition between the oropharynx and nasopharynx that is lined by mucous membrane.
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
Levator veli palatini is a cylindrical muscle that arises from a small tendon on the inferior, roughened, portion of the petrous temporal bone, known as the quadrate area, situated in front of the inferior opening of the carotid canal. Some of its fibres also originate from the lower part of the cartilaginous pharyngotympanic tube and yet more from the vaginal process of the tympanic bone. It inserts onto the nasal surface of the palatine aponeurosis and sits between the two heads of the palatopharyngeus muscle, forming a rounded belly. The levator muscles pass anteromedially and together they form a V-shaped sling just above and behind the palatine aponeurosis, which allows elevation and slight retraction of the vertical posterior part of the soft palate when closure of the nasopharynx is required. The soft palate then touches the posterior pharyngeal wall, closing off the nasopharyngeal isthmus to prevent nasal regurgitation during speech and swallowing. Additionally, its fibres also pull the lateral nasopharyngeal wall anteromedially to narrow that space. The effects of levator veli palatini on the pharyngotympanic tube and its role in the equalization of air pressure are controversial. This muscle, along with the palatoglossus, palatopharyngeus and uvular muscle, are all supplied by the cranial part of the accessory nerve via the pharyngeal plexus.
Medical Negligence in Otorhinolaryngology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Excessive resection of the soft palate leading to velopharyngeal incompetence can occur. Where these changes in speech and swallowing reverse within a few weeks a defence can usually be mounted. However if the changes due to nasal escape persist beyond two years the loss of soft palate tissue is usually so excessive that a defence is impossible.
A computational model of upper airway respiratory function with muscular coupling
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Olusegun J. Ilegbusi, Don Nadun S. Kuruppumullage, Matthew Schiefer, Kingman P. Strohl
Figure 4 shows the predicted width of airway lumen at four reference levels; (i) soft palate, (ii) tongue, (iii) epiglottis, and (iv) larynx. First, the dimensions were recorded when the upper airway structure was in the standing position with gravitational effect in the vertical downward direction (Figure 4(a)). Figure 4(b) shows the result when the upper airway structure is in the supine position to mimic the sleeping posture. Figure 4(c) shows the corresponding result in the supine position when the dilator muscles are activated. All four reference levels in Figure 4 show a slight decrease in airway lumen size due to the weight of the tissue. This partial collapse is particularly noticeable at the soft palate, epiglottis and the laryngeal levels, as the epiglottis level defines the minimum gap. Figure 4(c) shows the recovery of the airway with the activation of the dilator muscles. Specifically, the dilator muscle activation causes the anterior wall of the airway lumen at all three levels to move forward and the cross-sectional dimensions of the airway to increase.
Safety review of current systemic treatments for severe chronic rhinosinusitis with nasal polyps and future directions
Published in Expert Opinion on Drug Safety, 2021
The exhalation delivery system has been shown to improve drug delivery to the posterior and superior sinonasal spaces while reducing deposition in the non-ciliated nasal vestibule [31]. During exhalation, the soft palate elevates due to positive pressure in the oropharynx, which in turn isolates the nasal cavity from the rest of the respiratory system [32]. In theory, this should allow good nasal and sinus distribution while limiting systemic absorption. A 3-month double-blinded RCT reported fluticasone to be well tolerated when delivered through an exhalation device [8]. A 12-month single-arm study evaluating the safety and efficacy of the exhalation system with fluticasone found a number of local adverse events, including epistaxis (11.2%), nasal erythema (17.5%) and acute sinusitis (13.9%) [33]. Ocular examination, including the intraocular pressure, was all normal with no evidence of glaucoma or subcapsular cataracts [33]. A similar 12-month single-arm study suggested a similar safety profile with nasal mucosal disorders (10.2%) and epistaxis (6.8%) noted as the only adverse events [34].
Speech in 5-year-olds born with unilateral cleft lip and palate: a Prospective Swedish Intercenter Study
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Kristina Klintö, Karin Brunnegård, Christina Havstam, Malin Appelqvist, Emilie Hagberg, Ann-Sofie Taleman, Anette Lohmander
This is the first article to report on speech outcome for children with unilateral cleft lip and palate (UCLP) at 5 years of age, in a prospective longitudinal intercentre study including all cleft lip and palate (CLP) centres in Sweden. In Sweden, about 200 children are born with cleft palate ± lip every year [8]. The teams are multidisciplinary, and each of the six centres covers a regional area. All children are referred to the regional centre soon after birth, and followed up until the age of 19 with few families dropping out. The cleft surgery is carried out according to different methods at the centres. Currently, the cleft in the palate is closed in either one stage at 9–12 months or at ∼18 months, or in two stages, with soft palate closure at ∼6 months of age and hard palate closure at about 24 months. The age of 5 years is important for follow-up of speech, since our goal is good speech at the start of school at 6 years of age. We also know that typically developing children have mostly developed adult-like speech at the age of 5 years, except for simplification of /r/ and /s/ [9]. Therefore, in Sweden, 5 years of age has been agreed on for follow-up at all CLP centres.