A quantitative histologic study of the normal human adult soft palate.

This study was designed to re-examine the same soft palates studied qualitatively in a previous investigation (Kuehn and Kahane, 1990), using a true-color image analysis system. The quantified measures of the areas of specific tissue types are reported. The results indicate that: (a) tendinous tissue is prominent anteriorly and comprises about 10% of total tissue in that region, (b) the relative proportion of glandular and connective tissue is fairly uniform across the length of the soft palate, averaging 22% and 36% respectively, (c) muscle tissue shows a pattern of increasing then decreasing amount from anterior to posterior with a maximum proportion of 23% in the midportion of the soft palate, (d) adipose tissue comprises 22% of total tissue area in the anterior segment and 17% of total tissue area in the posterior segment of the soft palate, (e) other tissue, primarily epithelium and vascular tissue, was found to be fairly constant anteriorly and increased in relative proportion to almost 30% of the total tissue area at the uvular base. The functional implications of these findings are discussed.

Respiratory and acoustic signals associated with bolus passage during swallowing.

In order to advance our understanding of the relation between respiration and deglutition, simultaneous videofluoroscopy and respirodeglutometry was performed. Fifteen normal, healthy, young adults (20-29 years of age) were connected to a respirodeglutometer and positioned for simultaneous videofluoroscopic assessment in the lateral plane. Subjects performed three swallows each of a 5-ml and a 10-ml bolus of liquid barium and a 5-ml bolus of paste barium, for a total of nine swallows per subject. Location of the bolus head as identified with videofluoroscopy was associated with eight respirodeglutometric variables. In addition, temporal relations for seven respirodeglutometric variables were calculated as a function of bolus volume and viscosity. Significant temporal differences were found for five of the variables by volume. No significant temporal differences were noted by viscosity. Expiration occurred before 79% and after 96% of the swallows. The number of inspirations preceding a swallow suggested a possible effect resulting from the need to hold a bolus in the mouth before receiving instructions to swallow during videofluoroscopic assessment. This effect may be important during patient evaluation. For a significant number of swallows, respiratory flow ceased before the velum was fully elevated.

Ultrasonic quantification of geniohyoid cross-sectional area and tissue composition: a preliminary study of age and radiation effects.

BACKGROUND: This study developed and used a new, noninvasive approach to quantify cross-sectional area and tissue composition within the geniohyoid (GH) muscle in normal adults and head and neck cancer patients. METHODS: B-mode ultrasound was used to measure GH cross-sectional area at rest and during four speech gestures and GH tissue composition at rest in normal young adults, patients with SCC head and neck cancer treated with primary radiotherapy, and normal older adults age matched with the patients. RESULTS: Patients exhibited significantly greater GH cross-sectional area than young subjects at rest and in effortful conditions. Significantly greater muscle tissue variability across GH quadrants was observed in patients compared with normal subjects and in older compared with younger subjects. CONCLUSIONS: B-mode ultrasound area analyses and tissue classification techniques can be used to quantify muscle changes, such as those resulting from age, radiotherapy, or rehabilitation for head and neck cancer.

Magnetic resonance imaging in the evaluation of occult submucous cleft palate.

OBJECTIVE: To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with occult submucous cleft palate and to use the MRI information obtained to aid in the treatment decision to perform surgery versus behavioral speech therapy. DESIGN: Prospective study with magnetic resonance (MR) images of subjects suspected of having occult submucous cleft palate. SETTING: Hospital and university-based. PATIENTS: Two girls who were 4 years old at the time of palatal surgery. INTERVENTION: Furlow double-opposing Z-plasty. MAIN OUTCOME MEASURES: MR images and clinical speech evaluations. RESULTS: MR images provided evidence of an interruption of levator veli palatini muscle tissue in the midline and a substantial attachment of levator muscle tissue to the posterior border of the hard palate. In addition, MR images for both subjects demonstrated remarkably similar bilateral encapsulating sheaths that contained nonmuscular tissue, as confirmed subsequently during surgery. The encapsulating sheaths interrupted the normal progression of the levator muscle sling across the midline. The MR images led to the decision to perform surgery instead of speech therapy. Hypernasality was markedly reduced in both subjects after surgery. CONCLUSIONS: MRI is an effective technique for diagnosing occult submucous cleft palate and may be an important aid in the treatment decision regarding surgery versus behavioral speech therapy for patients diagnosed with occult submucous cleft palate.