粘膜下口蓋裂と先天性鼻咽腔閉鎖不全症-組織学的画像的検討-

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It has been considered that the cause of velopharyngeal insufficiency (VPI) is inadequate mobility of the soft palate resulting from an interruption and/or atrophic changes of the levator veli palatini muscle (LVP).The patients were classified into three group: 89 SMCP patients with Calnan's trias, 90 patients without the trias, and 42 patients with one or two part of the trias. Comparisons were made with respect to the mobility of the soft palate and lateral pharyngeal wall, histological configuration of muscle fibers and the status of the LVP, as determined by MRI.There was no significant difference among the three groups with respect to the morphology of the nasopharynx or mobility of the soft palate and lateral wall. Histological examination showed obvious atrophy of the LVP in all CVPI cases especially those without Calnan's trias, while changes in those with SMCP were less pronounced.Surprisingly, the muscle atrophy in SMCP patients was slight, whereas it was more pronounced in patients with CVPI. Thus, SMCP is characterized by abnormal development of the LVP and negligible muscle atrophy. In contrast, CVPI is characterized by conspicuous muscular lesions. These results suggest the involvement of myogenic or neurogenic factors in the pathogenesis of their diseased states.
耳鼻咽喉科臨床学会の論文