Lateral Approach to the Levator Veli Palatini: A Preliminary Report

2009 ◽  
Vol 46 (3) ◽  
pp. 292-294 ◽  
Author(s):  
Vipul Nanda ◽  
Puneet Tuli ◽  
Ramesh Kumar Sharma
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Preliminary Report ◽  
Lateral Approach ◽  
Medial Approach ◽  
Levator Veli Palatini ◽  
Lateral Incision ◽  
Long Time ◽  
Abnormal Anatomy ◽  
Radical Reconstruction

The abnormal anatomy in the cleft palate has been of interest to surgeons for a long time. Different authors have independently evolved the techniques of radical reconstruction of the palatal musculature and have suggested the medial approach to dissect the levator. We hereby report the technique in which the levator is identified through the lateral incision of the soft palate. This lateral approach helps in the complete release of the levator from all abnormal attachments and ensures reconstruction of an effective sling. This technique is of particular benefit in a palate re-repair.

Patterns of Abnormal Myogenesis in Human Cleft Palates

1994 ◽  
Vol 31 (5) ◽  
pp. 345-350 ◽  
Author(s):  
Steven R. Cohen ◽  
Lynn L. Chen ◽  
Alphonse R. Burdi ◽  
Carroll-Ann Trotman
Keyword(s):  
Light Microscopy ◽  
Cleft Palate ◽  
Muscle Fiber ◽  
Soft Palate ◽  
Crown Rump Length ◽  
Levator Veli Palatini ◽  
Myotube Formation ◽  
Preliminary Study ◽  
Mesenchymal Condensation ◽  
First Time

To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n=4) to age-matched (n=3) and nonmatched (n=1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator veli palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed “normal” at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.

Patterns of Abnormal Myogenesis in Human Cleft Palates

1992 ◽  
Vol 29 (1) ◽  
pp. 345-350
Author(s):  
Steven R. Cohen ◽  
Lynn L. Chen ◽  
Alphonse R. Burdi ◽  
Carroll-Ann Trotman
Keyword(s):  
Light Microscopy ◽  
Cleft Palate ◽  
Muscle Fiber ◽  
Soft Palate ◽  
Crown Rump Length ◽  
Levator Veli Palatini ◽  
Myotube Formation ◽  
Preliminary Study ◽  
Mesenchymal Condensation ◽  
First Time

To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n=4) to age-matched (n=3) and nonmatched (n=1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator vell palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed “normal” at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.

Morphological Characterization of the Levator Veli Palatini Muscle in Children Born with Cleft Palates

2001 ◽  
Vol 38 (5) ◽  
pp. 438-448 ◽  
Author(s):  
Rolf Lindman ◽  
Gunnar Paulin ◽  
Per S. Stål
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Repair ◽  
Fiber Type ◽  
Muscle Spindles ◽  
Morphological Characterization ◽  
Velopharyngeal Insufficiency ◽  
Normal Adult ◽  
Levator Veli Palatini

Objective: The aim of this study was to analyze, morphologically and biochemically, one of the soft palate muscles, the levator veli palatini (LVP), in children born with cleft palate. Subjects and Methods: Biopsies were obtained from nine male and three female infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for comparison. The muscle morphology, fiber type and myosin heavy chain (MyHC) compositions, capillary supply, and content of muscle spindles were analyzed with different enzyme-histochemical, immunohistochemical, and biochemical techniques. Results: Compared with the normal adult subjects, the LVP muscle from the infantile subjects with cleft had a smaller mean fiber diameter, a larger variability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infantile subjects with cleft LVP either lacked muscle tissue or contained only a small amount. Conclusions: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might be related to different stages in maturation of the muscles, changes in functional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue in some of the cleft biopsies offers one possible explanation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.

Comparison of Outcome of Three Different Approaches for Supracondylar Humerus Fractures in Children

2021 ◽  
Vol 15 (10) ◽  
pp. 3482-3484
Author(s):  
Syed Usman Shah ◽  
Mohammad Younas ◽  
Naseer Ullah Khattak ◽  
Amina Gul Shehzar Khan ◽  
Sultan Shah ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Lateral Approach ◽  
Supracondylar Fractures ◽  
Medial Approach ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Group A ◽  
Humerus Fractures ◽  
Group B

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

A Comparison of the Effects of Veau-Wardill-Kilner Palatoplasty and Furlow Double-Opposing Z-Plasty Operations on Eustachian Tube Function

2000 ◽  
Vol 37 (3) ◽  
pp. 266-270 ◽  
Author(s):  
Ethem Güneren ◽  
Zafer Özsoy ◽  
Mithat Ulay ◽  
Erhan Eryilmaz ◽  
Haluk Özkul ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Eustachian Tube ◽  
Soft Palate ◽  
Surgical Anatomy ◽  
Eustachian Tube Function ◽  
Secretory Otitis Media ◽  
Significant Difference ◽  
Before And After ◽  
Tube Function

Objective The purpose of this study was to compare the effects of Veau-Wardill-Kilner (VWK) two-flap palatoplasty and Furlow double-opposing Z-plasty operations on eustachian tube (ET) opening in patients with cleft palate (CP). Design Twenty-six patients underwent CP repair between 1993 and 1997. VWK and Furlow operations were used in 13 patients each. All patients were examined by the otorhinolaryngologist before and after the operations; mean follow-up time was 27.3 months. Secretory otitis media (SOM), as identified by tympanograms, was the comparison criterion used. Results The prevalence of SOM was 69% (n = 18) in all CP patients pre-operatively. Among those with preoperative SOM, we did not find any statistically significant difference in the frequency of postoperative SOM between the two techniques. Conclusion This study suggests that there is no difference in postoperative ET function between patients undergoing either VWK or Furlow operations, in spite of the differences in muscle positioning in these operations. We discuss the implications of this finding in relation to surgical anatomy and histology of the soft palate muscles.

The Hybrid Palatoplasty: A Preliminary Report

1996 ◽  
Vol 4 (3) ◽  
pp. 1-7 ◽  
Author(s):  
David A Gillett ◽  
Howard M Clarke
Keyword(s):  
Postoperative Complications ◽  
Cleft Palate ◽  
Preliminary Report ◽  
Speech Development ◽  
Stable Point ◽  
Standard Procedures

A composite technique was developed for repair of the complete unilateral cleft palate. Using a Veau type pushback on the cleft side simplified anterior closure, and the cleft hemipalate was lengthened. A von Langenbeck procedure on the noncleft side minimized anterior raw area and provided a stable point for fixation. Fourteen consecutive patients with unilateral complete cleft palate underwent hybrid palatoplasties. There were no significant intra- or postoperative complications. No differences in speech development have been noted. The procedure was no more difficult than either of the standard procedures and offers technical and theoretical benefits.

Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation in Cleft Palate Subjects

1995 ◽  
Vol 32 (5) ◽  
pp. 376-381 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Cleft Palate ◽  
Air Pressure ◽  
Levator Muscle ◽  
Emg Activity ◽  
High Activation ◽  
Levator Veli Palatini ◽  
Activation Level ◽  
High Activation Level ◽  
Intraoral Air Pressure ◽  
Total Activation

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed In relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.

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