Finkelstein Y, Shapiro-Feinberg M, Talmi Y P, Nachmani A, DeRowe A, Ophir D
Department of Radiology, Meir Hospital, Kfar Saba, Israel.
Cleft Palate Craniofac J. 1995 Jul;32(4):299-305. doi: 10.1597/1545-1569_1995_032_0299_acotvv_2.3.co_2.
The variability of the normal velopharyngeal (VP) closure mechanism was studied by investigating VP anatomy in relation to its closure mechanism in 60 patients. The axial configuration of the VP isthmus, as observed in axial CT scans at rest, was found to be correlated with VP function in terms of its closure patterns in speech as observed by nasendoscopy. A flat VP isthmus was found to be closed mainly in the anteroposterior direction, forming the coronal closure pattern. A deep VP isthmus is closed by movement of the velum and medial movement of the lateral pharyngeal walls, forming the circular closure pattern. A flat VP isthmus occurs when the hamuli are posteriorly located and the muscular slings, therefore, open more posteriorly. We conclude that posterior insertion of the velar muscles on to the skull base results in a flatter, larger VP axial configuration, whereas an anterior insertion results in a VP axial configuration that is deeper and less flat. A flat VP isthmus contracts mainly in an anteroposterior direction, exhibiting a coronal closure pattern, while a deep or round VP isthmus contracts centripetally, exhibiting a circular closure pattern. Variability of the VP valving mechanism is of anatomic and not of functional origin.
通过研究60例患者的腭咽（VP）解剖结构及其闭合机制，探讨了正常腭咽闭合机制的变异性。在静息状态下的轴向CT扫描中观察到的VP峡部的轴向构型，与鼻内镜观察到的言语中VP的闭合模式下的VP功能相关。发现扁平的VP峡部主要在前后方向闭合，形成冠状闭合模式。深的VP峡部通过软腭的运动和咽侧壁的向内运动而闭合，形成圆形闭合模式。当翼钩位于后方时，VP峡部呈扁平状，因此肌肉吊带在更后方打开。我们得出结论，腭肌向后插入颅底会导致VP轴向构型更扁平、更大，而向前插入则会导致VP轴向构型更深且不那么扁平。扁平的VP峡部主要在前后方向收缩，呈现冠状闭合模式，而深的或圆形的VP峡部向心收缩，呈现圆形闭合模式。VP瓣膜机制的变异性源于解剖结构而非功能。
