Uvula

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Uvula
LuettePalatineUvula.svg
Mouth of a child showing the uvula and swollen tonsils
Details
Pronunciation /ˈjuːvjʊlə/
Location Human mouth
Identifiers
Latin uvula palatina
MeSH D014609
TA98 A05.2.01.004
TA2 2781
FMA 55022
Anatomical terminology

The uvula (pl.: uvulas or uvulae), also known as the palatine uvula, is a conic projection from the back edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers. [1] [2] It also contains many serous glands, which produce thin saliva. [3] It is only found in humans. [4]

Contents

Structure

Muscle

The muscular part of the uvula (Latin : musculus uvulae) shortens and broadens the uvula. This changes the contour of the posterior part of the soft palate. This change in contour allows the soft palate to adapt closely to the posterior pharyngeal wall to help close the nasopharynx during swallowing. [5]

Its muscles are controlled by the pharyngeal branch of the vagus nerve.

Variation

The bifid uvula of a 24-year-old woman Tanya Uvula.jpg
The bifid uvula of a 24-year-old woman

A bifid or bifurcated uvula is a split or cleft uvula. Newborns with cleft palate often also have a split uvula. The bifid uvula results from incomplete fusion of the palatine shelves but it is considered only a slight form of clefting. Bifid uvulas have less muscle in them than a normal uvula, which may cause recurring problems with middle ear infections. While swallowing, the soft palate is pushed backwards, preventing food and drink from entering the nasal cavity. If the soft palate cannot touch the back of the throat while swallowing, food and drink can enter the nasal cavity. [6] Splitting of the uvula occurs infrequently but is the most common form of mouth and nose area cleavage among newborns. Bifid uvula occurs in about 2% of the general population, [7] although some populations may have a high incidence, such as Native Americans who have a 10% rate. [8]

Bifid uvula is a common symptom of the rare genetic syndrome Loeys–Dietz syndrome, [9] which is associated with an increased risk of aortic aneurysm. [10]

Function

During swallowing, the soft palate and the uvula move together to close off the nasopharynx, and prevent food from entering the nasal cavity.

It has also been proposed that the abundant amount of thin saliva produced by the uvula serves to keep the throat well lubricated. [3]

It has a function in speech as well. In many languages, a range of consonant sounds, known as uvular consonants, are articulated by creating a constriction of airflow between the uvula and the back of the tongue. The voiced uvular trill, written [ʀ] in the International Phonetic Alphabet, is one example; it is used in French, Arabic and Hebrew, among other languages. Due to the large amount of saliva produced from glands in the uvula that are absent in other mammals, it has been suggested that the uvula is an accessory speech organ. [4]

Stimulation of the uvula also causes the gag reflex to initiate. This is often a problem for people with uvula piercings, and a common method of inducing vomiting.[ citation needed ] It also acts as a food sensor/guard helping breathing in between mouth fulls, stopping small pieces of food being inhaled causing choking

Clinical significance

Inflammation

A swollen uvula with additional upper mouth ulcer in a run-down adult (common cold) Swollen Uvula.jpg
A swollen uvula with additional upper mouth ulcer in a run-down adult (common cold)

At times, the mucous membrane around the uvula may swell, causing the uvula to expand 3–5 times its normal size. This condition is known as uvulitis. When the uvula touches the throat or tongue, it can cause sensations like gagging or choking, although there is no foreign matter present. This can cause problems with breathing, talking, and eating.

There are many theories about what causes the uvula to swell, including dehydration (e.g. from arid weather); excessive smoking or other inhaled irritants; snoring; allergic reaction; or a viral or bacterial infection. An aphthous ulcer which has formed on the uvula can also cause swelling and discomfort. [11]

If the swelling is caused by dehydration, drinking fluids may improve the condition. If the cause is a bacterial infection, gargling salt water may help. However, it can also be a sign of other problems. Some people with a history of recurring uvulitis carry an epinephrine autoinjector to counteract symptoms of an attack. A swollen uvula is not normally life-threatening and subsides in a short time, typically within a day.

Snoring and sleep apnea

The uvula can also contribute to snoring or heavy breathing during sleep; having an elongated uvula can cause vibrations that lead to snoring. In some cases this can lead to sleep apnea, which may be treated by removal of the uvula or part of it if necessary, an operation known as uvulopalatopharyngoplasty (commonly referred to as UPPP, or UP3). However, this operation can also cause sleep apnea if scar tissue forms and the airspace in the velopharynx is decreased. The success of UPPP as a treatment for sleep apnea is unknown, but some research has shown 40–60% effectiveness in reducing symptoms. [12] Typically apnea subsides for the short term, but returns over the medium to long term, and sometimes is worse than it was before the UPPP.[ citation needed ]

Velopharyngeal insufficiency

In a small number of people, the uvula does not close properly against the back of the throat, causing a condition known as velopharyngeal insufficiency. This causes "nasal" (or more properly "hyper-nasal") speech, where extra air comes down the nose, and the speaker is unable to say certain consonants, such as pronouncing 'b' like 'm'.

Nasal regurgitation

During swallowing, the soft palate and the uvula move superiorly to close off the nasopharynx, preventing food from entering the nasal cavity. When this process fails, the result is called nasal regurgitation. It is common in people with VPI, the myositides, and neuromuscular disease. Regurgitation of fluids in this way may also occur if a particularly high volume of liquid is regurgitated, or during vigorous coughing, for example being caused by the accidental inhalation of water. Due to the action of coughing preventing the uvula from blocking the nasopharynx, liquid may be expelled back through the nose.

Society and culture

A child's swollen uvula with tonsils Swollenuvula.jpg
A child's swollen uvula with tonsils

In some parts of Africa, including Somalia, Ethiopia and Eritrea, the uvula or a section of it is ritually removed by a traditional healer. [13] In this case, the uvula may be noticeably shortened. It is not thought to contribute to velopharyngeal inadequacy, except in cases where the tonsils have also been removed. [14]

History

Etymology

In Latin, ūvula means "little grape", the diminutive form of ūva "grape" (of unknown origin). A swollen uvula was called ūva. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Otorhinolaryngology</span> Medical specialty

Otorhinolaryngology is a surgical subspeciality within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face, scalp, and neck.

Swallowing, also called deglutition or inglutition in scientific contexts, is the process in the body of a human or other animal that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing is an important part of eating and drinking. If the process fails and the material goes through the trachea, then choking or pulmonary aspiration can occur. In the human body the automatic temporary closing of the epiglottis is controlled by the swallowing reflex.

<span class="mw-page-title-main">Snoring</span> Vibratory sound made while asleep

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation.

<span class="mw-page-title-main">Cleft lip and cleft palate</span> Medical condition

A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate contains an opening into the nose. The term orofacial cleft refers to either condition or to both occurring together. These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders.

<span class="mw-page-title-main">Soft palate</span> Flexible part of maxilla

The soft palate is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone.

<span class="mw-page-title-main">Adenoid</span> Type of tonsil

In anatomy, the pharyngeal tonsil, also known as the nasopharyngeal tonsil or adenoid, is the superior-most of the tonsils. It is a mass of lymphatic tissue located behind the nasal cavity, in the roof of the nasopharynx, where the nose blends into the throat. In children, it normally forms a soft mound in the roof and back wall of the nasopharynx, just above and behind the uvula.

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

<span class="mw-page-title-main">Uvulopalatopharyngoplasty</span> Surgical procedure

Uvulopalatopharyngoplasty is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be removed include:

Velopharyngeal inadequacy is a malfunction of a velopharyngeal mechanism which is responsible for directing the transmission of sound energy and air pressure in both the oral cavity and the nasal cavity. When this mechanism is impaired in some way, the valve does not fully close, and a condition known as 'velopharyngeal inadequacy' can develop. VPI can either be congenital or acquired later in life.

Pharyngeal flap surgery is a procedure to correct the airflow during speech. The procedure is common among people with cleft palate and some types of dysarthria.

Somnoplasty is a trademark by Somnus Medical Technologies used for its radiofrequency ablation medical devices cleared by the Food and Drug Administration (FDA) to treat habitual snoring, chronic nasal obstruction, and obstructive sleep apnea (OSA) to shrink the tissues that are causing obstruction. Somnoplasty is typically an outpatient procedure that takes 30–45 minutes.

Velopharyngeal insufficiency is a disorder of structure that causes a failure of the velum to close against the posterior pharyngeal wall during speech in order to close off the nose during oral speech production. This is important because speech requires sound and airflow to be directed into the oral cavity (mouth) for the production of all speech sound with the exception of nasal sounds. If complete closure does not occur during speech, this can cause hypernasality and/or audible nasal emission during speech. In addition, there may be inadequate airflow to produce most consonants, making them sound weak or omitted.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

<span class="mw-page-title-main">Pharynx</span> Part of the throat that is behind the mouth and nasal cavity

The pharynx is the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea. It is found in vertebrates and invertebrates, though its structure varies across species. The pharynx carries food to the esophagus and air to the larynx. The flap of cartilage called the epiglottis stops food from entering the larynx.

<span class="mw-page-title-main">Mouth assessment</span> Part of patient assessment performed on the mouth

A mouth assessment is performed as part of a patient's health assessment. The mouth is the beginning of the digestive system and a substantial part of the respiratory tract. Before an assessment of the mouth, patient is sometimes advised to remove any dentures. The assessment begins with a dental-health questionnaire, including questions about toothache, hoarseness, dysphagia, altered taste or a frequent sore throat, current and previous tobacco use and alcohol consumption and any sores, lesions or bleeding of the gums.

<span class="mw-page-title-main">Maxillary hypoplasia</span> Medical condition

Maxillary hypoplasia, or maxillary deficiency, is an underdevelopment of the bones of the upper jaw. It is associated with Crouzon syndrome, Angelman syndrome, as well as Fetal alcohol syndrome. It can also be associated with Cleft lip and cleft palate. Some people could develop it due to poor dental extractions.

<span class="mw-page-title-main">Hypernasal speech</span> Medical condition

Hypernasal speech is a disorder that causes abnormal resonance in a human's voice due to increased airflow through the nose during speech. It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter. In normal speech, nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal speech is the opening and closing of a velopharyngeal passage way between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.

Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.

<span class="mw-page-title-main">Velopharyngeal port</span>

The velopharyngeal port or velopharyngeal sphincter is the passage between the nasopharynx and the oropharynx. It is closed off by the soft palate and uvula against the rear pharyngeal wall during swallowing to prevent food and water from entering the nasal passages. During speech, it is open for nasal sounds and closed for oral sounds. It is affected by cleft palate, resulting in velopharyngeal consonants.

References

  1. ↑ "eMedicine Definition". Archived from the original on 2008-02-16. Retrieved 2008-05-03.
  2. ↑ Ten Cate's Oral Histology, Nanci, Elsevier, 2007, page 321
  3. 1 2 Back, GW; Nadig, S; Uppal, S; Coatesworth, AP (December 2004). "Why do we have a uvula?: literature review and a new theory". Clinical Otolaryngology and Allied Sciences. 29 (6): 689–93. doi:10.1111/j.1365-2273.2004.00886.x. PMID   15533161.
  4. 1 2 Finkelstein Y, Meshorer A, Talmi Y, Zohar Y, Brenner J, Gal R (1992). "The riddle of the uvula". Otolaryngol Head Neck Surg. 107 (3): 444–50. doi:10.1177/019459989210700318. PMID   1408233. S2CID   25135787.
  5. ↑ Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, page 108
  6. ↑ "Split Uvula: Is It a Problem?". Archived from the original on 14 October 2007. Retrieved 23 September 2007.
  7. ↑ Shu, M.D., Jennifer (April 12, 2010). "Will a bifid uvula cause any problems?". CNN . Retrieved 2010-08-07.
  8. ↑ McMillan, Julia A.; Feigin, Ralph D.; DeAngelis, Catherine; Jones, M. Douglas (2006). Oski's pediatrics: principles & practice (4th ed.). Lippincott Williams & Wilkins. p. 469. ISBN   978-0-7817-3894-1.
  9. ↑ "Loeys-Dietz Syndrom Foundation". Archived from the original on 5 August 2012. Retrieved 25 March 2010.
  10. ↑ Vilacosta, Isidre; Godoy, Victoria Cañadas (2008). "Bifid Uvula and Aortic Aneurysm". New England Journal of Medicine. 359 (2): e2. doi:10.1056/NEJMicm070582. PMID   18614778.
  11. ↑ Biblo LA, Gilbert IA (May 1983). "Aphthous ulcer of the uvula and the painful burp". N. Engl. J. Med. 308 (19): 1168. doi:10.1056/NEJM198305123081922. PMID   6835348.
  12. ↑ Lehnert, Paul (3 August 2005). "Uvulopalatopharyngoplasty for obstructive sleep apnea" . Retrieved 26 October 2006.
  13. ↑ Ethiopian Refugees
  14. ↑ Hartley B, Rowe-Jones J (1994). "Uvulectomy to prevent throat infections". J Laryngol Otol. 108 (1): 65–6. doi:10.1017/s0022215100125873. PMID   8133174.
  15. ↑ The American Heritage Dictionary of the English Language (4th ed.). Boston: Houghton Mifflin. 2000. p.  1896. ISBN   978-0618082308.
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