Hemiuvulectomy: is it a suitable alternative?

Abstract

The uvula is a vital organ of the craniofacial complex that is responsible for speech, swal- lowing, and mastication. It develops from the muscular component of the fourth pharyngeal arch during the first 6weeks of life. Over the next 1 to 2weeks, mesodermal tissues migrate and differentiate within the arch before organizing to form the specific muscle fibers that constitute the uvula muscle. It is the only intrinsic muscle of the soft palate; it is a paired, thin, sagit- tally oriented muscle that occupies the most medial and nasal position of the soft palate, occupying the posterior three-quarters of the velum. Like other intrinsic muscles, its primary function is to modify shape, not position. This muscle contributes to velopharyngeal compe- tence through both active and passive mech- anisms. The primary macroscopic movement induced by the uvula is to shorten the soft palate. This produces a localized protrusión of tissue (muscular, glandular, and connec- tive tissue) on the medial and nasal aspect of the levator veli palatini muscle, known as the levator eminence, which contributes to active velopharyngeal closure. A bifid uvula can occur in isolation or in association with a submucous cleft. The uvula is a delicate structure compared with the rest of the palate. During cleft palate repair, it can be difficult for surgeons to meticulously suture both hemiuvulae using the conven- tional repair technique and achieve satisfac- tory esthetic results.