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Obesity has emerged as a pressing concern in contemporary society, prompting an increase in bariatric surgery (BS) procedures for severe obesity management. Post-bariatric weight loss might cause complications, such as a reduction in the soft tissue surrounding the Eustachian tube, potentially affecting its function. This cohort prospective study, conducted between May and December 2022, aimed to assess the impact of post-bariatric acute weight loss on Eustachian tube function. A total of 54 cases of bariatric surgery and 157 control subjects were included in the study. Data on socio-demographics, weight, and the type of bariatric surgery were collected for the study group. ET function was assessed using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Approximately 55% of the participants fell within the age range of 18-25 years, with the majority (91.4%) having not undergone bariatric surgery. Conversely, participants who underwent BS were significantly more prevalent in the older age groups, specifically those over 50, between 40-50, and 31-40 years (p<0.001). Our sample consisted of 82.5% females and 17.5% males, with BS being significantly more common among male subjects (45.9%) compared to females (21.3%) (p=0.002). The mean total ETDQ-7 in control subjects was significantly higher (11.29±5.49) compared to those who had BS (9.11±4.09). Moreover, when comparing the ETDQ-7 between subjects who had BS and the control group, no statistically significant differences were observed in the total ETDQ-7 score and across all seven items within the ETDQ-7. Based on these findings, bariatric surgery did not have a major effect on ET function.

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OBJECTIVE: There have been few studies on the anatomy of palatine aponeurosis (PA). Herein, we elucidated the relationship between the PA and soft palate muscles and pharyngeal muscles. DESIGN: Two cadaveric specimens were dissected to observe the gross anatomy of the PA. Six cadaveric specimens were processed and scanned by micro-computed tomography to determine the elaborate anatomy. Images were exported to Mimics software to reconstruct a three-dimensional model. RESULTS: The PA covered the anterior (32.1%-38.8%) of the soft palate, extending from the tensor veli palatini (TVP) and connecting to 3 muscles: palatopharyngeus (PP), uvula muscle, and superior pharyngeal constrictor (SC). The SC and PP are attached to the PA on the medial side of the pterygoid hamulus. SC muscle fibers were attached to the hamulus, forming a distinct gap between the hamulus. Some muscle fibers of the PP and uvula originated from the PA. The PA extended from the TVP to the midline and the posterior edge of the hard palate. The PA was not uniformly distributed, which was complementary to the attached muscles in thickness. CONCLUSIONS: PA, as a flexible fibrous membrane, maintains the shape of the soft palate. It extends from the TVP and covers anteriorly about one-third of the soft palate. The PA provides a platform for the soft palate muscles and pharyngeal muscles, connecting to the PP, uvula muscle, and SC. These muscles are important for palatopharyngeal closure and middle-ear function. It is necessary to minimize the damage to the PA during surgical interventions.

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The digastricus and omohyoideus muscles are digastric muscles with two muscle bellies. An insertion tendon of the posterior belly becomes an intermediate tendon in digastricus muscles, whereas a single band-like muscle in omohyoideus muscles may later be interrupted by an intermediate tendon, possibly due to muscle cell death caused by mechanical stress. In human foetuses, an intermediate tendon provides the temporal origins of the tensor veli palatini and tensor tympani muscles. Some reptiles, including snakes, carry multiple series of digastric-like axial muscles, in which each intersegmental septum is likely to become an intermediate tendon. These findings indicate that many pathways are involved in the development of digastric muscles. A review of these morphologies suggested that the flexor digi-torum superficialis (FDS) muscle was a digastric muscle, although the intermediate tendon may not be visible in the surface view in adults. The present observations support the hypothesis that the proximal anlage at the elbow develops into a deep muscle slip to a limited finger, while the distal anlage at the wrist develops into the other slips. The findings suggest that, in the FDS muscle, the proximal and distal bellies of the embryonic digastric muscle fuse together to form a laminar structure, in which muscle slips accumulate from the palmar to the deep side of the forearm. (Folia Morphol 2018; 77, 2: 362-370).

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The eustachian tube consists of 2 compartments: the Rüdinger's safety canal and the auxiliary gap. It is surrounded by a cartilaginous wall on the craniomedial side and a membranous wall on the inferolateral side. The eustachian tube cartilage is firmly attached to the skull base by the lateral and the medial suspensory ligaments, which are separated by the medial Ostmann fat pad. The function of the isometric tensor veli palatini muscle is modulated by hypomochlia, which have an influence on the muscular force vectors.

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OBJECTIVE: Otitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited. This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair. MATERIALS AND METHODS: A literature search on the MEDLINE database was performed using a combination of the keywords "tensor veli palatini muscle," "Eustachian tube," "otitis media with effusion," and "cleft palate." RESULTS: Several studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tube's dilatation mechanism. CONCLUSION: More research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems. CLINICAL RELEVANCE: Optimized surgical management of cleft palate could potentially reduce associated middle ear problems.

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Some researchers contend that in adults the tensor tympani muscle (TT) connects with the tensor veli palatini muscle (TVP) by an intermediate tendon, in disagreement with the other researchers. To resolve this controversy, we examined serial sections of 50 human embryos and fetuses at 6-17 weeks of development. At 6 weeks, in the first pharyngeal arch, a mesenchymal connection was found first to divide a single anlage into the TT and TVP. At and after 7 weeks, the TT was connected continuously with the TVP by a definite tendinous tissue mediolaterally crossing the pharyngotympanic tube. At 11 weeks another fascia was visible covering the cranial and lateral sides of the tube. This "gonial fascia" had two thickened borders: the superior one corresponded to a part of the connecting tendon between the TT and TVP; the inferior one was a fibrous band ending at the os goniale near the lateral end of the TVP. In association with the gonial fascia, the fetal TT and TVP seemed to provide a functional complex. The TT-TVP complex might first help elevate the palatal shelves in association with the developing tongue. Next, the tubal passage, maintained by contraction of the muscle complex, seems to facilitate the removal of loose mesenchymal tissues from the tympanic cavity. Third, the muscle complex most likely determined the final morphology of the pterygoid process. Consequently, despite the controversial morphologies in adults, the TT and TVP seemed to make a single digastric muscle acting for the morphogenesis of the cranial base.

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The aim of the present article is to describe the mechanical components of the auditory tube and the role of these components in auditory tube function. Particular attention will be given to those aspects which have not been sufficiently dealt with in the past, such as the role of the isthmus region, the function of the lateral mucosal folds, the significance of the surfactant proteins and the pathophysiology of the patulous auditory tube. Special attention is given to the tensor veli palatini muscle and its physiology. Because of its isometric contraction, the function of this muscle depends on so-called hypomochlia changing the direction of its force. In the context of this article, the three hypomochlia involved are the pterygoid hamulus, Ostmann's fatty tissue and the medial pterygoid muscle.The so-called "Eppendorf-maneuver" is depicted for the first time.