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The blood supply of the levator and tensor veli palatini muscles
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ABSTRACTS
The blood supply of the levator and tensor veli palatini muscles E. FREEDLANDER Department of Anatomy, University of Glasgow
Although of obvious importance to cleft palate surgeons, there has been no detailed investigation of the blood supply of the levator and tensor veli palatini muscles. A series of 32 hemifacial dissections has been carried out on 5 adult human cadavers and 11 foetuses (of 20-26 weeks’ gestation). The specimens had previously been injected with either red neoprene latex or Schlesinger’s medium to outline the arterial tree. The foetuses were dissected using a dissection microscope and the adult cadavers by gross dissection with loupe magnification as required. The levator and tensor muscles were each found to have a dual blood supply normally. The levator received its supply from the ascending palatine and
ascending pharyngeal arteries. The tensor gained supply from the ascending palatine and accessory meningeal arteries. In five dissections the ascending palatine artery failed to reach the levator and tensor. In these cases the sole supply to the former muscle appeared to come from the ascending pharyngeal. The points of entry of branches of these vessels into the muscles were fairly constant. As it enters the soft palate, the ascending palatine artery passes very close to the pterygoid hamulus. Here it appears to be at risk of damage during standard dissection used in cleft palate closure. Examination of the course of the vessels in a cleft palate foetus showed a very similar pattern.
Neonatal cleft lip repair in Ayrshire E. FREEDLANDER,
M. H. C. WEBSTER,
R. B. LEWIS,
M. BLAIR
and S. KNIGHT
Seafield Children’s Hospital, A yr
Thirty-one children born in Ayrshire, Scotland, between May 1978 and August 1987 with various types of cleft underwent lip procedures in the early neonatal period, without mortality. As soon as possible after the birth the child was examined by a consultant paediatrician. Any potential management problem was identified, and neonatal repair was ruled out in two cases. Operation was carried out within the first 48 hours in 26 of the 31 cases. Twenty-six cases (84%) were reviewed, the longest follow-up period being 9 years and the shortest 3 months. A grading chart was used to assess the result. Eleven cases were rated as excellent/good, 9 as satisfactory/fair and 6 as poor. Three of the poor results were on bilateral complete
clefts of the lip and palate. Seven cases (27% of those reviewed) have undergone lip revision procedures. There were no significant anaesthetic complications. The only significant surgical complication was dehiscence of 3 out of 9 lip adhesions performed. The excellent quality of the lip scar was noticeable in many cases. The authors believe the main argument in favour of neonatal repair is the psychological benefits it brings to the parents of the child. As the results can be as good as those obtained at several months of age, and as the procedure is safe, consideration should be given to earlier repair becoming more established practice.
ABSTRACTS
The blood supply of the levator and tensor veli palatini muscles E. FREEDLANDER Department of Anatomy, University of Glasgow
Although of obvious importance to cleft palate surgeons, there has been no detailed investigation of the blood supply of the levator and tensor veli palatini muscles. A series of 32 hemifacial dissections has been carried out on 5 adult human cadavers and 11 foetuses (of 20-26 weeks’ gestation). The specimens had previously been injected with either red neoprene latex or Schlesinger’s medium to outline the arterial tree. The foetuses were dissected using a dissection microscope and the adult cadavers by gross dissection with loupe magnification as required. The levator and tensor muscles were each found to have a dual blood supply normally. The levator received its supply from the ascending palatine and
ascending pharyngeal arteries. The tensor gained supply from the ascending palatine and accessory meningeal arteries. In five dissections the ascending palatine artery failed to reach the levator and tensor. In these cases the sole supply to the former muscle appeared to come from the ascending pharyngeal. The points of entry of branches of these vessels into the muscles were fairly constant. As it enters the soft palate, the ascending palatine artery passes very close to the pterygoid hamulus. Here it appears to be at risk of damage during standard dissection used in cleft palate closure. Examination of the course of the vessels in a cleft palate foetus showed a very similar pattern.
Neonatal cleft lip repair in Ayrshire E. FREEDLANDER,
M. H. C. WEBSTER,
R. B. LEWIS,
M. BLAIR
and S. KNIGHT
Seafield Children’s Hospital, A yr
Thirty-one children born in Ayrshire, Scotland, between May 1978 and August 1987 with various types of cleft underwent lip procedures in the early neonatal period, without mortality. As soon as possible after the birth the child was examined by a consultant paediatrician. Any potential management problem was identified, and neonatal repair was ruled out in two cases. Operation was carried out within the first 48 hours in 26 of the 31 cases. Twenty-six cases (84%) were reviewed, the longest follow-up period being 9 years and the shortest 3 months. A grading chart was used to assess the result. Eleven cases were rated as excellent/good, 9 as satisfactory/fair and 6 as poor. Three of the poor results were on bilateral complete
clefts of the lip and palate. Seven cases (27% of those reviewed) have undergone lip revision procedures. There were no significant anaesthetic complications. The only significant surgical complication was dehiscence of 3 out of 9 lip adhesions performed. The excellent quality of the lip scar was noticeable in many cases. The authors believe the main argument in favour of neonatal repair is the psychological benefits it brings to the parents of the child. As the results can be as good as those obtained at several months of age, and as the procedure is safe, consideration should be given to earlier repair becoming more established practice.