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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
Tensor veli palatini is a veil-thin triangular muscle arising from the scaphoid fossa of the sphenoid bone, the lateral lamina of the pharyngotympanic tube and the spine of the sphenoid. It descends on the lateral surface of the medial pterygoid plate and then forms a tendon that hooks around the pterygoid hamulus to spread out to form the palatine aponeurosis. Its two sides fuse in the median raphe. Upon bilateral contraction, the muscles tauten predominantly the anterior part of the soft palate and depress the arch. Unilateral contraction of the muscles moves the soft palate in the direction of the pull. A primary function of the tensor veli palatini muscle is also presumed to be associated with opening the pharyngotympanic tube during swallowing and yawning to allow for equalization of nasopharyngeal and middle ear air pressure. This explains why patients with cleft palate will almost universally have otitis media with effusion; due to a failure of the midline connection, the tensor veli palatini cannot pull open the pharyngotympanic tube and, so, aeration of the middle ear as well as protecting it from the transmission of infections from the pharynx is negligible. The tensor veli palatini is the only muscle of the palate that is supplied by a branch of the mandibular division of the trigeminal nerve – the nerve to medial pterygoid. The rest are supplied by the cranial part of the accessory nerve via the pharyngeal plexus.
Chronic Otitis Media
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
George G. Browning, Justin Weir, Gerard Kelly, Iain R.C. Swan
The incidence of COM in cleft palate patients followed up to 10 years of age is around 20%, with 2% of them having a cholesteatoma.113 The tensor veli palatini muscle is hypoplastic in cleft palate children and may predispose to Eustachian tube dysfunction.114
Head and neck
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Muscles of soft palate– tensor veli palatini– levator veli palatini– palatoglossus– palatopharyngeus
Outcome of the ‘waiting until spontaneous extrusion’ strategy for long-term tympanostomy tube placement in children with cleft palate
Published in Acta Oto-Laryngologica, 2022
Yuri Nomura, Hidetoshi Oshima, Kazuhiro Nomura, Risako Kakuta, Ryoukichi Ikeda, Ai Kawamoto Hirano, Jun Ota, Tetsuaki Kawase, Yukio Katori
CP is common craniofacial birth defect and affects approximately 1/800 live births worldwide, especially in individuals of Asian and Amerindian origins, where it affects 1/500 live births [2]. Children with CP experience various difficulties in feeding, speech, dentition, and hearing [3]. OME is a common complication in children with CP, with previous studies reporting that its incidence was 74.7% in children of five years of age [3] or up to 97% in children of up to two years of age [4]. Although CP itself is correctable by craniofacial surgery, the muscles controlling the Eustachian tube are difficult to repair. In children with CP, the tensor veli palatini and lavator veli palatini muscles, which are involved in opening the Eustachian tube, show an abnormal insertion and the tube fails to open properly [3]. As a result, ventilation of the middle ear cavity is impaired and mucous accumulates in the cavity [3]. Therefore, in children with CP, there is a strong tendency for the recurrence of OME and most of these patients undergo surgery for VT placement [1,5].
Long-term outcomes in children with and without cleft palate treated with tympanostomy for otitis media with effusion before the age of 2 years
Published in Acta Oto-Laryngologica, 2020
Maki Inoue, Mariko Hirama, Shinji Kobayashi, Noboru Ogahara, Masahiro Takahashi, Nobuhiko Oridate
Otitis media with effusion (OME) is common in infants with cleft palate due to Eustachian tube (ET) dysfunction [1]. Various studies have reported that up to 90% and more of children with cleft palate may suffer from OME [2,3]. In children with cleft palate, ET dysfunction is probably caused by abnormal insertion of the tensor veli and levator veli palatini muscles. The tensor veli palatini muscle is involved in middle ear ventilation through the ET opening mechanism. Velopharyngeal disclosure, owing to the levator veli palatini muscle impairment, may also lead to ET dysfunction, specifically related to peritubal lymphoid hyperplasia, resulting from soiling of the nasal cavity with food [1]. Additionally, poor ventilation of the middle ear cavity owing to ET dysfunction causes negative pressure and retraction of the tympanic membrane (TM), thus leading to OME.
Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study
Published in Acta Oto-Laryngologica, 2020
Jung Mee Park, Woo Jin Kim, Jae Sang Han, So Young Park, Shi Nae Park
Palatal myoclonic tinnitus (PMT) is a rare otological condition classified as objective tinnitus or somatosound of muscle origin. It is caused by rhythmic voluntary or involuntary movements of the soft palate, mainly involving the tensor veli palatini and levator veli palatine muscles. Palatopharyngeus, salpingopharyngeus, and superior pharyngeal constrictor muscles may also be associated with PMT. The most common symptom is a ‘clicky’ noise in the ear, frequently occurring in a pulsatile manner. Rhythmic contraction of the soft palate on oral or nasal endoscopy is a critical diagnostic clue of PMT. Physicians can also objectively hear the ‘clicky’ sound using the Toynbee tube.