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Review
. 2016 Sep;20(7):1389-401.
doi: 10.1007/s00784-016-1828-x. Epub 2016 May 7.

The Role of the Tensor Veli Palatini Muscle in the Development of Cleft Palate-Associated Middle Ear Problems

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Free PMC article
Review

The Role of the Tensor Veli Palatini Muscle in the Development of Cleft Palate-Associated Middle Ear Problems

David S P Heidsieck et al. Clin Oral Investig. .
Free PMC article

Abstract

Objective: Otitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited. This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair.

Materials and methods: A literature search on the MEDLINE database was performed using a combination of the keywords "tensor veli palatini muscle," "Eustachian tube," "otitis media with effusion," and "cleft palate."

Results: Several studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tube's dilatation mechanism.

Conclusion: More research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems.

Clinical relevance: Optimized surgical management of cleft palate could potentially reduce associated middle ear problems.

Keywords: Cleft palate; Eustachian tube; Otitis media with effusion; Tensor veli palatini muscle.

Figures

Fig. 1
Fig. 1
The tensor veli palatini muscle originates from the cranial base and lateral side of the auditory tube (Eustachian tube). In this figure, the tensor veli palatini muscle’s auditory tube origin is represented at the cartilaginous and membranous parts of the lateral auditory tube. Before entering the soft palatum, the tensor veli palatini muscle tendon wraps itself around pterygoid hamulus. Insertion ratio: The insertion ratio as described by Matsune and Sando [13] is calculated by the length of Eustachian tube cartilage involved by insertion of the tensor veli palatini muscle at the auditory tube (line B) divided by the total length of the Eustachian tube (line A); the length of the auditory tube cartilage from the nasopharyngeal end to isthmus portion. (Figure adapted from Matsune et al. [13])
Fig. 2
Fig. 2
C Eustachian tube cartilage, L Eustachian tube lumen, Line A connection between two most distant points of Eustachian tube lumen; Line A separates the Eustachian tube cartilage into the lateral lamina (LL) and the medial lamina (ML); LL/ML ratio: Area of lateral lamina divided by the area of the medial lamina. (Adapted from Matsune et al. [19])
Fig. 3
Fig. 3
Photomicrograph of cross sections through the midcartilaginous portion of the Eustachian tube: a control case (6-week old female) and b cleft palate case (7-week old male). The photomicrographs show differences in curvature of the lumen and cross-sectional area of the Eustachian tube development of the cartilage between the normal child and the child with a cleft palate (hematoxylin-eosin stain). ETC Eustachian tube cartilage, L Eustachian tube lumen, LL lateral lamina of Eustachian tube cartilage, ML medial lamina, TVPM tensor veli palatini muscle. (Reproduced with permission from Matsune. [19])

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