Vascular anatomy of the velopharyngeal muscles and its clinical implications: A fresh cadaveric study based on micro‐computed tomography

Abstract

Poor speech improvement after levator veli palatini (LVP) reconstruction may be related to intraoperative vascular injury. We aimed to examine the vascular anatomy of the velopharyngeal muscles to provide a guide for arterial protection in cleft palate repair. Fresh adult cadaveric heads were injected with gelatin/lead oxide. The velopharyngeal specimens were stained with iodine and scanned using micro‐computed tomography. Three‐dimensional reconstruction models were obtained using a computer‐aided design software. The ascending palatine artery (APaA), especially the posterior branch, is the main artery supplying the velopharyngeal muscles. The posterior branch of the APaA reaches the dorsal part of the musculus uvulae in the posterior one third of the soft palate (SP) and lies 1.75 mm (standard deviation, 0.06) under the nasal mucosa; the anterior branch penetrates the anterolateral side of the LVP to reach the anterior one third of the SP and lies 7.09 mm (0.03) under the oral mucosa. The posterior APaA, anterior ApaA, and ApaA trunk had mean diameters of 0.41 mm (0.04), 0.46 mm (0.06), and 0.65 mm (0.04) at 0.5, 1, and 1.5 cm distance from the palatal midline, respectively. To minimize vascular injury, mobilization of muscles during intravelar veloplasty should be performed within a distance of 1 cm from the palatal midline, and dissection of the oral submucosa should be reduced in the anterior one third of the SP, while wide dissection of the nasal submucosal should be avoided in the posterior one third of the SP.

Is the collateral circulation pattern in the hard palate affected by cleft deformity?

“…Likewise, the typical course of the vessels within the tissue layers must be understood to define optimal soft tissue handling and selection of dissection planes during cleft repair. This specifically applies to the LPA branches that supply the minor salivary glands, predominantly at the posterior aspect of the hard palate [ 8 , 9 ]. Preserving circulation through these arterial anastomoses is essential in cleft palate surgery to ensure safe healing and minimize scarring.…”