Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model.
Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model.
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DOI：
10.1097/sap.0000000000000777
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发表时间：
2016-02
影响因子：
1.5
通讯作者：
Blemker SS
中科院分区：
文献类型：
--
作者：
Inouye JM;Lin KY;Perry JL;Blemker SS
软腭帆背侧的凸面对于正常的腭咽（VP）功能是至关重要的，并且主要归因于腭帆提肌（LVP）和悬雍垂肌（MU）。研究表明，鼻软膜表面凹陷或平坦与VP功能障碍的症状（包括鼻音过重和鼻内排气）相关。在腭裂手术修复的背景下，与较大的LVP相比，文献中对MU的关注相对较少。更好地理解MU的机制将提供深入了解畸形MU的影响，如腭裂中所见，因为它与VP功能有关。本研究的目的是在计算模型中量化MU对VP闭合的贡献。我们创建了一个新的三维有限元模型的VP机制从MRI数据收集的个人与健康的非分裂VP解剖。模型组件包括软腭、咽后壁（PPW）、LVP和MU。模拟基于文献中的肌肉和软组织力学特性。我们发现，与先前的假设类似，MU充当i）占位结构和ii）软腭伸肌。作为一种占位结构，MU有助于将中线VP接触长度增加近三倍。作为一个软腭伸肌，MU单独行动，没有LVP的VP距离减少62%。此外，MU的激活将闭合所需的LVP激活降低了近三倍，从20%（无MU）降至8%（有MU）。我们的研究表明，任何可能的挽救和解剖重建的可行MU组织在一个分裂的病人可能会改善VP关闭由于其机械功能。在MU组织缺失或功能障碍的情况下，在软膜中线植入自体或工程组织（作为MU的可能替代物）可能会产生更有利于VP闭合的几何凸度。在未来，更复杂的模型将提供进一步了解最佳的手术重建VP肌肉组织在正常和腭裂人群。
The convexity of the dorsal surface of the velum is critical for normal velopharyngeal (VP) function and is largely attributed to the levator veli palatini (LVP) and musculus uvulae (MU). Studies have correlated a concave or flat nasal velar surface to symptoms of VP dysfunction including hypernasality and nasal air emission. In the context of surgical repair of cleft palates, the MU has been given relatively little attention in the literature compared with the larger LVP. A greater understanding of the mechanics of the MU will provide insight into understanding the influence of a dysmorphic MU, as seen in cleft palate, as it relates to VP function. The purpose of this study was to quantify the contributions of the MU to VP closure in a computational model. We created a novel 3D finite element model of the VP mechanism from MRI data collected from an individual with healthy non-cleft VP anatomy. The model components included the velum, posterior pharyngeal wall (PPW), LVP, and MU. Simulations were based on the muscle and soft tissue mechanical properties from the literature. We found that, similar to previous hypotheses, the MU acts as i) a space-occupying structure and ii) a velar extensor. As a space-occupying structure, the MU helps to nearly triple the midline VP contact length. As a velar extensor, the MU acting alone without the LVP decreases the VP distance 62%. Furthermore, activation of the MU decreases the LVP activation required for closure almost three-fold, from 20% (without MU) to 8% (with MU). Our study suggests that any possible salvaging and anatomical reconstruction of viable MU tissue in a cleft patient may improve VP closure due to its mechanical function. In the absence or dysfunction of MU tissue, implantation of autologous or engineered tissues at the velar midline, as a possible substitute for the MU, may produce a geometric convexity more favorable to VP closure. In the future, more complex models will provide further insight into optimal surgical reconstruction of the VP musculature in normal and cleft palate populations.