The soft roof of the mouth is the posterior fibro muscular portion of the roof of the mouth that is attached to the posterior border of the difficult palate1. It participates in most unwritten maps, particularly velopharyngeal closing which is related to the normal maps of suction, get downing and pronunciation2.Development of roof of the mouth is formed by the merger of three constituents, they are two palatine procedures and the crude roof of the mouth formed from the frontonasal procedure. At a ulterior phase, the mesoblast in the roof of the mouth undergoes intramembraneous ossification to organize the difficult roof of the mouth. However ossification does non widen into the most posterior part which remains as the soft roof of the mouth. Early mentions refering the nonsubjective measurings of the soft roof of the mouth have been contributed by research workers interested in address, map and upper airway structures3-10, 14. .Although these continued attempts toward the dimensional analysis of the soft roof of the mouth and its environing constructions have been made, small attending has been paid to the assortment of soft roof of the mouth morphology and constellation. By detecting the image of the soft roof of the mouth on sidelong cephalometry, we noticed that the constellation of the soft roof of the mouth presented diversely in normal persons. It was irrational to depict the morphology of the soft roof of the mouth as merely one sort in the published literature. Pepin et Al found the ”hooked ” visual aspect of the soft roof of the mouth in awake patients, which indicated a high hazard for clogging sleep apnoea syndrome ( OSAS ) 12. The aquiline visual aspect of the soft roof of the mouth has besides been observed in our current survey and was described as ”S-shaped ” in our categorization. However, in our current survey we besides found all the six types of velar morphology as observed by M You Li, W Wang et al 1. The intent of the present survey was to look into the fluctuation of soft roof of the mouth morphology. The relative differences of the soft roof of the mouth between gender groups were studied every bit good. This survey can be helpful for understanding the assorted morphologies of the soft roof of the mouth in the average sagittal plane on sidelong cephalograms. It is hoped that these findings may be used non merely as mentions for normal soft roof of the mouth, but for dissected Reconstruction and the aetiological research of clogging sleep apnea syndrome ( OSAS ) and other conditions.
Materials and Methods:
100 digital sidelong cephalograms of normal topics ( 46 work forces and 54 adult females, with age runing 15-35 old ages ) were taken from the Department of Oral Medicine and Radiology & A ; , Department of Orthodontia, Meenakshi Ammal Dental College, Chennai. All topics had normal speech map and none had any history of cleft roof of the mouth or syndromes nor diseases or break of the caput and cervix.
All sidelong cephalograms were taken utilizing a DIMAX 3 CEPH ( PLAN MECA PROMAX ) . The tube potency was adjusted to optimise the contrast of both difficult and soft tissues ( 85 kilovolt ) . Digital radiogram were processed and viewed by utilizing PICASA PHOTO VIEWER software.13
All of the radiogram were observed and categorized into six types. Since there was no difference in their categorization, dependability was considered to be more than adequate for the intent of this survey.
By detecting the image of the veil on sidelong cephalograms, we classified them into six types on the footing of the assorted radiographic visual aspects. The image and line drawing of each are given in Figures 1-6. All 100 topics were categorized harmonizing to the radiographic characteristics in the above mentioned figures.
Type 1: ”leaf form ” , which was lanceolate, indicated that the in-between part of the soft roof of the mouth elevated to both the naso and the oro-side 40 ( 40 % ) instances. Type 2: when the soft roof of the mouth showed that the anterior part was inflated and the free border had an obvious constriction, the radiographic visual aspect was described as holding a ”rat-tail form ” 28 ( 28 % ) instances. Type 3: a ”butt-like ” soft roof of the mouth showed a shorter and fatter veil visual aspect, and the breadth had about no distinguishable difference from the anterior part to the free border 15 ( 15 % ) instances. Type 4 indicated that the image of the soft roof of the mouth presented a ”straight line form ” 12 ( 12 % ) instances. Type 5: The deformed soft roof of the mouth, presented the S-shape 2 ( 2 % ) instances. Type 6 revealed a ”crook ” visual aspect of the soft roof of the mouth, in which the posterior part of the soft roof of the mouth criminals anteriosuperiorly 3 ( 3 % ) instances. Distribution and proportion of these types are presented in Table 1.
Cephalometric analysis is one of the most normally accepted techniques for measuring the soft roof of the mouth in both normal persons and those with dissected roof of the mouth. Cephalometry is a comparatively cheap method and permits a good appraisal of the soft tissue elements that define the soft roof of the mouth and its environing structures7. Morphometric appraisal of the nasopharynx or the constellation of next constructions can be defined in footings of deepness and tallness in the average sagittal plane on sidelong cephalograms. The dimensional analysis of the soft roof of the mouth and its surrounding constructions, particularly the velar length and breadth, has been studied by many research workers. However, the assortment of velar morphology, which has been ignored in the yesteryear, is logically responsible for the significantly different dimensions on soft roof of the mouth, such as velar length and breadth.
The digital radiographic technique, used in the current survey, is based on the rule of slit skiagraphy. We were able to take the image scanning from posterior to anterior in the sagittal plane, and adjust and optimise the contrast and the step with professional PICASA PHOTO VIEWER package. Therefore, the soft roof of the mouth visual aspect and diagnostic information can be enhanced and elicited, which benefits the probe and assesment.13
In our survey, the leaf-shaped soft roof of the mouth was the most frequent type 40 ( 40 % ) instances ) , which is an expected determination since this type was antecedently described as a authoritative velar morphology in the literature. The S-shape, which was described as a aquiline visual aspect of the soft roof of the mouth by Pepin et Al, was found in 2 ( 2 % ) instances in our survey. Hooking of the soft roof of the mouth was defined in their survey as an angulation of about 30A° between the distal portion of the uvula and the longitudinal axis of the soft palate12. They hypothesized that soft roof of the mouth draw plays a cardinal function in guttural prostration, since hooking consequences in a sudden and major decrease in the oropharyngeal dimensions, which hence dramatically increases upper air passage opposition and the transpharyngeal force per unit area gradient. Pepin et al hence concluded that draw of the soft roof of the mouth in patients indicates a high hazard for clogging sleep apnea syndrome ( OSAS ) .
Therefore, it is a likely hypothesis that velopharyngeal adequateness is strongly dependent on a close coordination of the anatomic parts involved in velopharyngeal closing: the soft roof of the mouth and the immediate guttural constructions. Since the harmoniousness of the veil and environing pharyngeal constructions seems to be indispensable for velopharyngeal closing, it is sensible to speculate that the immediate guttural constructions may hold different features to fit up to different velar morphology. Further survey should hence be focused on whether differences exist among the pharyngeal constructions of each type. Even after closing of the soft tissue defect in patients with dissected roof of the mouths, normal map of the soft roof of the mouth is often non achieved15. The fluctuation of the soft roof of the mouth morphology may be a new account for surgical failure and the soft roof of the mouth should be repaired in assorted forms.
The morphology of the soft roof of the mouth can be divided into six types harmonizing to their characteristics on sidelong cephalometry. This categorization can assist us better understand the diverseness of the velar morphology in the average sagittal plane. These findings can be used as mentions for the research of velopharyngeal closing in cleft roof of the mouth persons and for aetiological research of OSAS and other conditions.
M You, X Li, H Wang* , J Zhang, H Wu, Y Liu, J Miao and Z Zhu ; Morphological assortment of the soft roof of the mouth in normal persons: a digital cephalometric survey ; Dentomaxillofacial Radiology ( 2008 ) 37, 344-349.
Moore KL, Agur AMR. Essential clinical anatomy ( 2nd edn ) . Philadelphia, PA: Lippincott, Williams and Wilkins, 2002.
Johns DF, Rohrich RJ, Awada M. Velopharyngeal incompetency: a usher for clinical rating. Plas Reconstr Surg 2003 ; 112: 1890-1898.
Subtelny JD. A cephalometric survey of the growing of the soft roof of the mouth. Plast Reconstr Surg 1957 ; 443-454.
Satoh K, Wada T, Tachimura T, Fukuda J, Shiba R, Sakoda S. Comparison of nasopharyngeal growing between patients with clefts ( UCLP ) and non-cleft controls by multivariate analysis. Cleft Palate Craniofac J 1997 ; 34: 405-409.
Johnston CD, Richardson A. Cephalometric alterations in grownup guttural morphology. Eur J Orthod 1999 ; 21: 357-362.
Taylor M, Hans MG, Strohl KP, Nelson S, Broadbent BH. Soft tissue growing of the oropharynx. Angle Orthodontist 1996 ; 66: 393-400.
Kollias I, Krogstad O. Adult craniocervical and pharyngeal alterations – a longitudinal cephalometric survey between 22 and 42years of age. Part II: morphology of uvulo glossopharyngeal alterations. Eur J Orthod 1999 ; 21: 345-355.
Maltais F, Carrier G Cormier Y, Series F. Cephalometric measurings in snorers, non-snorers, and patients with sleep apnoea. Thorax 1991 ; 46: 419-423.
Randall P, LaRossa D, McWilliams BJ, Cohen M, Solot C, Jawad AF. Palate length in cleft roof of the mouth as a forecaster of address result. Plast Reconstr Surg 2000 ; 106: 1254- 1259.
Lu Y, Shi B, Zheng Q, Xiao WL, Li S. Analysis of velopharyngeal morphology in grownups with velopharyngeal incompetency after surgery of a cleft roof of the mouth. Annalss Plast Surg2006 ; 57
Pepin JL, Veale D, Ferretti GR, Mayer P, Levy PA. Obstructive slumber apnea syndrome: aquiline visual aspect of the soft roof of the mouth in awake patients – cephalometric and CT findings. Radiology 1999 ; 210: 163-170.
Saunders Jr RS, Samei E. A method for modifying the image quality parametric quantities of digital radiographic images. Med Phys 2003 ; 30: 3006-3017.
Hoopes JE, Dellon AL, Frabrikant JI. Cineradiographic definition of the functional anatomy and pathophysiology of the velopharynx. Cleft Palate J 1970 ; 7: 443-454.
Simpson RK, Austin AA. A cephalometric probe of velar stretch. Cleft Palate J 1972 ;