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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
Oral cavity
Published in Paul Ong, Rachel Skittrall, Gastrointestinal Nursing, 2017
The soft palate extends posteriorly to the uvula which can be observed suspended into the palatoglossal arch. The uvula prevents the premature movement of nutrients into the pharynx. Movement of the soft palate is achieved by contraction of the levator veli palatini and tensor veli palatini muscles. This is important during swallowing, as elevation of the soft palate prevents nutrients from passing into the nasopharynx. The muscles also open the entrance to the auditory tubes. Posterior to the palatoglossal arch is the palatopharyngeal arch. The palatine tonsils sit on both sides of the oral cavity between the palatoglossal and palatopharyngeal arches. This opening between the oral cavity and oropharynx is called the fauces.
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
The boundary between the soft and hard palate is easily palpable and is characterized by a subtle change in colour; the soft palate is characterized by a yellowish discolouration on a background of a darker red than that visible in the region of the hard palate. The soft palate is essentially a thick mucosal fold that holds within it an aponeurosis, muscles, neurovascular structures, lymph nodes and mucous glands. In its relaxed state, it is pendulant and a midline raphe is visible on its concave oral surface. The soft palate requires an intact central fibrous aponeurosis formed by the fused expanded tendons of the tensor veli palatini muscles upon which the muscles attached to the palate can act. The aponeurosis is attached posteriorly to the palatine part of the hard palate and has a midline raphe. The soft palate has a thicker anterosuperior portion near its insertion with the hard palate. As the palate travels posteroinferiorly, it gradually thins out, giving off the characteristic curved lower border appearance as it merges with the palatoglossal muscles which insert into it. In the centre is the conical uvula, part of its free inferior border, which can vary in length (but is typically longer in those who snore or have sleep apnoea) and projects downwards. The uvular muscles are embedded in the aponeurosis which splits to surround them. From the uvula, the two muscles of the pharyngeal arches—palatopharyngeus and palatoglossus—diverge laterally and inferiorly and insert into the intrinsic muscles of the tongue. The mucosa of the soft palate is covered in mucinous glands as well as minor salivary glands, and some taste buds exist on its oral surface.
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.