title: The innervation of the soft palate muscles involved in cleft palate: a review of the literature.
abstract: OBJECTIVE
  Surgical techniques to obtain adequate soft palate repair in cleft palate patients elaborate on the muscle repair; however, there is little available information regarding the innervation of muscles. Improved insights into the innervation of the musculature will likely allow improvements in the repair of the cleft palate and subsequently decrease the incidence of velopharyngeal insufficiency. We performed a literature review focusing on recent advances in the understanding of soft palate muscle innervation.
  
  
  METHODS
  The Medline and Embase databases were searched for anatomical studies concerning the innervation of the soft palate.
  
  
  RESULTS
  Our literature review highlights the lack of accurate information about the innervation of the levator veli palatini and palatopharyngeus muscles. It is probable that the lesser palatine nerve and the pharyngeal plexus dually innervate the levator veli palatini and palatopharyngeus muscles. Nerves of the superior-extravelar part of the levator veli palatini and palatopharyngeus muscles enter the muscle form the lateral side. Subsequently, the lesser palatine nerve enters from the lateral side of the inferior-velar part of the levator veli palatini muscle. This knowledge could aid surgeons during reconstruction of the cleft musculature. The innervation of the tensor veli palatini muscle by a small branch of the mandibular nerve was confirmed in all studies.
  
  
  CONCLUSIONS
  Both the levator veli palatini and palatopharyngeus muscles receive motor fibres from the accessory nerve (through the vagus nerve and the glossopharyngeal nerve) and also the lesser palatine nerve. A small branch of the mandibular nerve innervates the tensor veli palatini muscle.
  
  
  CONCLUSIONS
  Knowledge about these nerves could aid the cleft surgeon to perform a more careful dissection of the lateral side of the musculature.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Robrecht J H
authors.initials: RJ
authors.lastname: Logjes
authors.affiliation: Division of Surgical Specialties, Department of Anatomy, University Medical Centre Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands.
authors.forename: Ronald L A W
authors.initials: RL
authors.lastname: Bleys
authors.affiliation: Division of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB, Utrecht, The Netherlands. c.c.breugem@umcutrecht.nl.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D006801:Humans; D010156:Palatal Muscles / Q000294:innervation* / Q000601:surgery*; D010160:Palate, Soft / Q000294:innervation* / Q000601:surgery*
keywords: Glossopharyngeal nerve; Lesser palatine nerve; Levator veli palatini; Palatopharyngeus; Pharyngeal plexus; Tensor veli palatini; Vagus nerve