Huang M H, Lee S T, Rajendran K
Department of Plastic Surgery at Singapore General Hospital.
Plast Reconstr Surg. 1997 Sep;100(4):833-42. doi: 10.1097/00006534-199709001-00003.
The aims of this anatomic investigation were to examine the levator veli palatini, tensor veli palatini, and salpingopharyngeus muscles in relation to normal eustachian tube function and to analyze the clinical implications of these data for tubal physiology in cleft palate individuals. Detailed dissections under 3.2x loupe magnification were conducted on the paratubal muscles of 15 fresh human adult cadaveric head specimens, paying particular attention to their cranial base anatomy. Each half of the cadaveric heads was examined separately, giving a sample size of 30. The cranial base origin of the levator veli palatini was the junction of the cartilaginous and bony parts of the eustachian tube. Contrary to statements in the existing literature, it had no origin from the quadrate area of the petrous temporal bone. In its path toward the velum, it was related inferiorly and lay almost parallel to the tube. The tensor veli palatini originated from the scaphoid fossa of the sphenoid bone and the tube. In contrast to previous descriptions, it was found to consist of a single sheet of muscle with no bilaminar structure. Its axis was oblique to that of the tube. The salpingopharyngeus was a slender muscle attached to the posteroinferior aspect of the pharyngeal end of the tube. It inserted into the palatopharyngeus inferiorly. These morphologic characteristics and anatomic relationships suggest that (1) the levator veli palatini opens the eustachian tube by isotonic contraction that results in displacement of the medial tubal cartilage and the tubal membrane, (2) the tensor veli palatini opens the tube directly by traction on the lateral tubal membrane and indirectly by rotation of the medial tubal cartilage by means of traction on the lateral tubal cartilage, (3) because of its consistently small size, the salpingopharyngeus is probably functionally the least important of the paratubal muscles, (4) the levator veli palatini is unable to cause tubal dilatation in cleft palate because it can only contract isometrically, and (5) tensor veli palatini function is probably unaffected by clefting. However, its mechanism of action may be disrupted iatrogenically by complete hamular fracture or division of its tendon.
本解剖学研究的目的是检查腭帆提肌、腭帆张肌和咽鼓管咽肌与咽鼓管正常功能的关系，并分析这些数据对腭裂患者咽鼓管生理的临床意义。在15个新鲜成人尸体头部标本的咽鼓管旁肌肉上，于3.2倍放大镜下进行详细解剖，特别注意其颅底解剖结构。尸体头部的每一侧分别进行检查，样本量为30。腭帆提肌的颅底起点是咽鼓管软骨部与骨部的交界处。与现有文献中的描述相反，它并非起自颞骨岩部的方形区。在其走向腭部的路径中，它位于咽鼓管下方且几乎与之平行。腭帆张肌起自蝶骨舟状窝和咽鼓管。与先前描述不同，发现它由单层肌肉组成，无双层结构。其走行轴与咽鼓管的轴呈斜向。咽鼓管咽肌是附着于咽鼓管咽端后下方的细长肌肉。它向下插入腭咽肌。这些形态学特征和解剖关系表明：（1）腭帆提肌通过等张收缩打开咽鼓管，导致咽鼓管内侧软骨和咽鼓管膜移位；（2）腭帆张肌通过直接牵拉咽鼓管外侧膜以及通过牵拉外侧软骨间接使内侧软骨旋转来打开咽鼓管；（3）由于其尺寸一直较小，咽鼓管咽肌在功能上可能是咽鼓管旁肌肉中最不重要的；（4）腭裂患者中腭帆提肌无法导致咽鼓管扩张，因为它只能进行等长收缩；（5）腭帆张肌的功能可能不受腭裂影响。然而，其作用机制可能因完全性翼钩骨折或肌腱断裂而受到医源性破坏。
