软腭及咽部肌肉神经解剖研究进展

A review of the anatomy of the innervation of the soft palate and pharyngeal muscles

该文综述了软腭及咽部肌肉神经解剖相关的研究进展。软腭部肌肉分为腭帆张肌、腭帆提肌、腭咽肌、腭舌肌及悬雍垂肌。其中, 腭帆张肌受三叉神经的下颌神经分支支配;大多数学者认为其他软腭肌由迷走神经、舌咽神经形成的咽丛分支支配, 面神经及腭小神经亦参与其中。咽肌可分为咽缩肌和咽提肌, 咽缩肌包括咽上缩肌、咽中缩肌及咽下缩肌;咽提肌包括茎突咽肌、腭咽肌和咽鼓管咽肌。咽上缩肌及咽中缩肌被认为由咽丛分支支配, 而咽下缩肌则由咽丛及喉部神经支配;茎突咽肌由舌咽神经分支支配, 而腭咽肌和咽鼓管咽肌则由咽丛分支支配。了解腭咽部肌肉的神经支配有助于减少腭裂修复术中的神经损伤, 有助于了解腭咽闭合不全所致的吞咽、发音等障碍的相关机制, 并指导神经源性吞咽困难及部分睡眠呼吸暂停综合征的治疗。

This review focuses on recent advances on innervation of velopharyngeal muscles.Soft palate muscles include tensor veli palatini(TVP),levator veli palatini(LVP),palatopharyngeus(PP),palatoglossus(PG)and uvularis(MU).TVP is innervated by mandibular nerve,a branch of the trigeminal nerve.However,present studies on the innervation of other soft palate muscles have yielded very controversial findings.The majority agree that they are innervated by the pharyngeal plexus,a plexus formed by pharyngeal branches of the glossopharyngeal(IX)and vagus(X)nerves.Some studies also found that the facial nerve and lesser palatine nerve innervate these muscles.Pharyngeal muscles consist of pharyngeal constrictors and levator pharyngeal muscles.The former includes the superior,middle and inferior pharyngeal constrictors.The latter includes stylopharyngeus,palatopharyngeus and salpingopharyngeus.They are all innervated by branches of pharyngeal plexus except from stylopharyngeus,which is only innervated by the glossopharyngeal nerve.Moreover,the inferior constrictor is also innervated by laryngeal nerves.It is profound and vital to figure out the innervation of the velopharyngeal muscles,which contributes to reducing nerve damage during cleft palate operation.It sheds new light on mechanisms of swallowing and phonation disorders which are caused by velopharyngeal insufficiency and it helps find proper clinical treatment to neurogenic dysphagia and sleeping apnea syndrome.