DR.NUAS HASAB JAFAR

Morbid anatomy and pathophysiology in the

cleft palate

Anatomy and physiology

In approaching any surgical problem, one must have understanding of both normal and abnormal anatomy

the muscles form opposing slings that meet in the soft palate raphe.

The tensors and levators form the superior sling .palatoglossus and palatopharangeus form the inferior ones.

there are velar elevators and velar

depressors The levator veli palatini

is the primary elevator of the

velum. It originates from the petrous

portion of thetemporal bone , and inserts into the palatal aponeurosis

 Another elevator is

the musculus uvulae

Contraction of this muscle shortens the soft palate,

basically bunching it up towards the

back.

Depressors are the two

palatoglossus muscles and the palatopharyngeus

muscles . The palatoglossus

originates from the palatal

aponeurosis and inserts into the

sides of the back of the tongue

Contraction both elevates the tongue and

depresses the velum.

They interdigitate with its partner on the opposite side in the midline of the soft palate

this muscle doesn't elevate the velum at all. It's sole function is to open the Eustachian tube to allow the air pressure in the middle ear to

equalize

And the last muscle is the

tensor veli palatin

In reality, the velum does not move like a hinged trap door but is only the anterior part

of a complex velopharyngeal valve which functions as a circular sphincter

`

*So here's a little physiology note: When at rest, the velum is depressed, allowing us to breath through our nose comfortably. So why do we need velar depressors? Well, the velum is elevated most of the time during speech (or singing), but when we want to make nasal sounds, like /m/ /n/ or nasal vowels, we've got to depress it very quickly. This is where the depressors come in, especially the palatoglossus. Allowing the elevators to simply relax would be too slow for comprehensible, flowing speech.

.Seal off the nasal from the oral cavities in order to isolate the oropharyngolaryngeal tract from atmospheric pressure during deglutition, producing a partial vacuum to facilitate compression of the food bolus by the tongue, cheeks, and pharynx, and therapy forcing it into

the esophagus. Open the Eustachian

tube It is very important for

the Eustachian Tubes to open (when swallowing)

so that pressure in the middle ear can be equalized with the

pressure in the atmosphere

if the tensor Palatini muscles don't contracted

The Eustachian Tubes would not opentherefore the middle ear pressure cannot be

equalized

.

With a cleft of the soft palate, the Levator Palatini from each side cannot interdigitate. As a result, the velum cannot

elevate.

Effects on Feeding:

Difficulty in forming negative pressure as air leaks to and

from the nasal cavities.Nasal regurgitation of milk,

liquids, vomit, solids

Effects on Hearing

Eustachian Tube dysfunction occurs in 95-100% of cases due to lack of interdigitation of the Tensor Palatini muscles. This

results in chronic and recurrent otitis media and

conductive hearing loss

.

.

.

Effects on Speech and Resonance

Difficulty building up positive pressure for high pressure

sounds

Hypernasality of vowels

Nasal air emission of consonants

Effects on Language

Development

Language may be delayed secondary to chronic otitis

media and conductive hearing loss

:

closing of cleft palate should provide a mechanism for normal

speech,hearing,dental occlusion,swallowing,and

separation of the oral and nasal cavities without interfering with

facial bone grouth.

Thank youThank you