Morbid anatomy and pathophysiology in the cleft palate
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Transcript of Morbid anatomy and pathophysiology in the cleft palate
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