Since Fujita first described uvulopalatopharyngoplasty(UPPP)in 1981,UPPP and its modified procedures have been widely used to treat obstructive sleep apnea and hyponea syndrome(OSAHS).However,despite of its wide application,the success rates was uncertain,ranging from 20% to 80%,with patients of varing Friedman stages.It is well known that the principle of UPPP is to remove the redundant tissue of palate,elongated uvula and hypertrophic tonsils in order to widen the anteroposterior space at the level of palate.But recently,surgeons have found that not only the collapse of soft palate but also the collapse of lateral wall at the palate level can contribute to the obstruction of upper airway at the level of palate.As a result,many surgeries which can widen the lateral velopharyneal space have sprung up in these years.This review focuses on the development of techniques that emphasize the enlargement of lateral velopharyneal space in patients with OSAHS.
Humans ; Larynx ; Palate ; anatomy & histology ; Palate, Soft ; Pharynx ; anatomy & histology ; Sleep Apnea, Obstructive ; therapy ; Uvula

OBJECTIVETo quantitatively compare the relationship between the congenital cleft palate and development of the palatal shelf.

METHODSFifty two pairs palatal shelves were macroscopic measured, and 60 series coronal sections were microscopically measured, which were precisely orientated in the coronal plane and serially sectioned at 7 micro m thickness. With the aid of computer imaging analysis system the widths and areas of the palatal shelves in vertical and coronal direction, the maximal areas of the palatal bone and palatal process and alveolar process were measured and compared quantitatively between the cleft group and non-cleft group.

RESULTSThe widths and areas of palatal shelves in cleft foetuses showed significant reduction macroscopically and microscopically as well as the maximal areas of the palatal bone, in addition, both of two processes of the maxilla showed significant developmental deficiency.

CONCLUSIONSThe palatal shelves show significant developmental hypoplasia in three dimension directions, which have significant correlation between palatal cleft and trisomic condition.

Animals ; Cleft Palate ; embryology ; genetics ; Female ; Image Processing, Computer-Assisted ; Mice ; Palate ; anatomy & histology ; embryology ; Trisomy

OBJECTIVEThe purpose of this study was to evaluate a new palatoplasty with persistent elastic distraction osteogenesis.

METHODSTwenty mongrel dog aged in 6 month were divided into two groups: the control (n = 10) and the experimental group (n = 10). The cleft palate model was made surgically in experimental dogs. The hard palate clefts were repaired with persistent elastic distraction osteogenesis. Then the animals were observed for an additional 12 weeks before sacrifice. Direct measurements was taken on dry skulls of the dogs and the data were analyzed statistically.

RESULTSFor all experimental dogs, the clefts were closed after gradual distraction. No relapse and airway blocking occurred in observational period. There were no significant differences in the variables of facial length, height and width between the two groups (P > 0.05). The length of horizontal portion of hard palate in experimental group was significantly longer than that in the control (P < 0.01).

CONCLUSIONThere was no complication and disturbance on maxillofacial structure in repairing cleft palate with persistent elastic distraction osteogenesis. It is an effective and safe technique for repairing cleft palate in animal model.

Animals ; Cleft Palate ; surgery ; Dogs ; Face ; anatomy & histology ; Osteogenesis, Distraction ; methods ; Palate ; surgery

OBJECTIVE: To discuss the soft palate, hard palate and mandibule for the pathogenesis and clinical treatment of patients who have obstructive sleep apnea hypopnea syndrome. METHOD: There were 52 patients with OSAHS diagnosed by the PSG and 32 cases of normal healthy volunteers in our hospital. All objects were given 128 slice spiral CT scan of the upper airway. We measured the related indexes of the soft palate, hard palate and mandible, then analysed statistical differences between them and did Pearson correlation analysis with apnea hypoventilation index (AHI), average blood oxygen saturation (MSaO2) in PSG. RESULT: Compared with the control group, the soft palate length [(37.93 ± 5.20)mm VS (33.52 ± 4.25)mm] and the distance between mandible with cervical vertebra [(75.00 ± 7.10)mm VS (69.93 ± 5.58)mm] increased significantly, but the distance of trailing edge of hard palate to inferior margin of slope significantly reduced [(42.57 ± 4.52)mm VS (45.80 ± 2.94)mm, P < 0.01] in patients with OSAHS. Each measurement associated with AHI and MSaO2 had no significant correlation (P > 0.05). CONCLUSION The soft palate, hard palate and mandibular are some of the important risk factors of OSAHS, and they also have reference value for the choice of clinical treatment operation. Preoperative CT examination can offer help in the treatment of OSAHS.
Case-Control Studies ; Humans ; Mandible ; anatomy & histology ; Oximetry ; Palate, Hard ; anatomy & histology ; Palate, Soft ; anatomy & histology ; Sleep Apnea, Obstructive ; diagnosis ; Tomography, Spiral Computed

INTRODUCTIONAccurate localisation of the greater palatine foramen (GPF) is imperative while negotiating the greater palatine canal for blocking the maxillary nerve within the pterygopalatine fossa. The aim of this study was to define the position of the foramen relative to readily identifiable intraoral reference points in order to help clinicians judge the position of the GPF in a consistently reliable manner.

METHODSThe GPF was studied in 100 dried, adult, unsexed skulls from the state of Maharashtra in western India. Measurements were made using a vernier caliper.

RESULTSThe mean distances of the GPF from the midline maxillary suture, incisive fossa, posterior palatal border and pterygoid hamulus were 14.49 mm, 35.50 mm, 3.40 mm and 11.78 mm, respectively. The foramen was opposite the third maxillary molar in 73.38% of skulls, and the direction in which the foramen opened into the oral cavity was found to be most frequently anteromedial (49.49%). In one skull, the greater and lesser palatine foramina were bilaterally absent. Except for the invariably present incisive canals, there were no accessory palatal foramina, which might have permitted passage of the greater palatine neurovascular bundle in lieu of the absent GPF. To the best of our knowledge, this is the first study of such a non-syndromic presentation.

CONCLUSIONThe GPF is most frequently palatal to the third maxillary molar. For an edentulous patient, the foramen may be located 14-15 mm from the mid-palatal raphe or about 12 mm anterior to the palpable pterygoid hamulus.

Anesthesia ; methods ; Cadaver ; Humans ; India ; Maxilla ; anatomy & histology ; innervation ; Maxillary Nerve ; pathology ; Molar ; anatomy & histology ; Palate, Hard ; abnormalities ; anatomy & histology ; innervation ; Reference Values ; Skull ; anatomy & histology

OBJECTIVE: To provide anatomic data of pterygopalatine fossa(PPF) for endoscopic PPF surgery. METHOD: Fifteen wet adult skull specimen fixed in 10% formaldehyde were studies. From center the skulls were sawed, the middle and inferior turbinate were resected, the anterior and posterior ethmoid sinuses were resected. Then after punch out perpendicular part of palatine bone and posterior wall of maxillary,the pterygopalatine fossa were showed and some related measurements were made. RESULT: This pathway can lead to a good view of pterygopalatine fossa. The main soft structures in PPF were maxillary artery and nerve with their branches. The diameter of artery branches was smaller than 3 mm. CONCLUSION The endoscopic PPF surgery is safe and practical from the anatomic data.
Adult ; Endoscopy ; Ethmoid Sinus ; anatomy & histology ; Humans ; Maxilla ; anatomy & histology ; Maxillary Artery ; anatomy & histology ; Maxillary Sinus ; anatomy & histology ; surgery ; Nasal Cavity ; surgery ; Palate, Hard ; anatomy & histology ; Pterygopalatine Fossa ; anatomy & histology ; surgery

OBJECTIVE: To inquiry the variety difference of upper airway caliber OSAHS sufferer and normal person in quiet respiration. METHOD: Twenty OSAHS sufferer who were viewed by PSG and 16 normal adults who hagve no chief complaint of sleeping disease were selected. The curves of the subjects in a respiratory cycle were recorded by respiratory monitoring system in PSG, while the morphological changes in the pharynx of all subjects were observed by fiberscope in a calm respiratory cycle, and then both of the two processes simultaneously were recorded on the same computer. According to the different stages of respiratory cycle by analyzing respiratory curve the video had been edited into pictures about the various anatomical areas in the upper airway, the cross section area and the dimension of palate and lingua and root of the tongue region upper airway whereas studied by the image tools in computer, and the changes of areas and dimensions at palate, and lingua and root of the tongue region upper airway were calculated. RESULT: It was found that there wasps a morphological change of the upper airway with the respiratory movement in the both groups. The upper airway caliber decrease with inspiration begin and reach the most narrowing at the end of inspiration, then upper airway caliber enlarges with the expiration begin and reach the most widening at the end of expiration. No matter the normal group or the OSAHS group has the obvious changes in the palate and lingua region on the diameter, the cross section area and the dimension in respiration. The changes in the palate and lingua region on the diameter, the cross section area and the dimension of OSAHS group were greater than normal group. No matter OSAHS group or normal group on the diameter and cross section area change in the palate was obviously more than the tongue area and the root of tongue area. The changes of OSAHS group on the dimension in the palate were greater than the tongue area and the root of tongue area. CONCLUSION There are periodically changes of upper airway during respiration cycle in normal adults and OSAHS patients. The effects of respiration on upper airway caliber of OSAHS patients are more obviously than normal adults, and the increasing effects in OSAHS patients is one of OSAHS etiology.
Adult ; Case-Control Studies ; Humans ; Male ; Middle Aged ; Palate ; anatomy & histology ; pathology ; Palate, Soft ; anatomy & histology ; pathology ; Pharynx ; anatomy & histology ; pathology ; Respiration ; Respiratory System ; Sleep Apnea, Obstructive ; pathology ; physiopathology ; Tongue ; anatomy & histology ; pathology

Adolescent ; Child ; Cleft Palate ; pathology ; Eustachian Tube ; anatomy & histology ; pathology ; Female ; Humans ; Male ; Nasopharynx ; anatomy & histology ; pathology ; Young Adult

OBJECTIVETo describe the morphology of upper airway in non-apnea males aged seventy years or over.

METHODSThirty-one non-apnea males aged 70 years or over [diagnosed by whole-night polysomnography (PSG), apnea and hypopnea index (AHI) < 10 per hour] had been taken magnetic resonance imaging (MRI) scanning.

RESULTSThe narrowest point of upper airway was at velopharynx. The mean and the minimum section areas were (190.9 +/- 67.1) mm(2) and (112.1 +/- 47.7) mm(2), respectively. Each sagittal/transverse ratio was between 0.22 and 0.89. It showed an ellipse-like cross-section of upper airway, while velopharynx was the most "slender" segment (sagittal/transverse-caliber was 0.22 - 0.71). The min/max section area of upper airway was between 0.38 and 0.62. It demonstrated that each airway segment was a "cone-like" form, while the velopharynx was the steepest segment.

CONCLUSIONSIn the non-apnea elderly males aged seventy years or over, the velopharynx was most likely to collapse.

Aged ; Aged, 80 and over ; Humans ; Magnetic Resonance Imaging ; Male ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology ; Polysomnography ; Sleep Apnea, Obstructive ; Surveys and Questionnaires ; Tongue ; anatomy & histology

OBJECTIVETo examine adaptive changes in the shape of the upper airway during titrated mandibular advancement. Furthermore, to understand the mechanism of mandible-adjustable therapy to improve the ventilation.

METHODSFourteen non-apnea participated in the study. A custom-made oral device was used to keep the mandible in titrated advancement at 0% (F0), 50% (F50), 75% (F75), 100% (F100) of the maximum advancement. Magnetic resonance imaging was used to investigate the difference in the shape of upper-airway in these 4 positions. Changes in the anteroposterior direction (AP), lateral direction (Lat) and its ratio (AP/Lat) were calculated, which were transformed into the percentage of the original ones.

RESULTSThe dose-dependent decrease of AP/Lat was found when the mandible was advanced (P = 0.0001). Lateral change rate in percentage increased by degrees (P = 0.0023), while the increase of anteroposterior change rate in percentage showed no statistical significance.

CONCLUSIONThe shape of upper airway tended to be less round. The enlargement of upper airway during titrated mandibular advancement was mainly the result of enlargement in lateral direction.

Asian Continental Ancestry Group ; Humans ; Magnetic Resonance Imaging ; Male ; Mandible ; anatomy & histology ; Mandibular Advancement ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology