Advertisement

The parapharyngeal adipose corpus: anatomic and radiologic study

  • Pauline Nicol
  • Jean-Marc Constans
  • Marie-Pia d’Ortho
  • Patrick Goudot
  • Christian VacherEmail author
Original Article
  • 29 Downloads

Abstract

Purpose

Although the morphology of the parapharyngeal adipose corpus (PAC) has been already described, the clinical interest of its volume and weight in the genesis of obstructive sleep apnea syndrome (OSAS) is still controversial. The volume of the PAC has been determined in OSAS patients but not in a normal population. The aim of our study was to investigate the morphology of the PAC by dissection and MRI in a normal population and to determine if there is a relation between the dimensions and volume of the PAC and the Body Mass Index (BMI).

Methods

Thirty hemifaces of 15 fresh cadavers have been dissected after silicone injection with dissection of the external carotid artery and its main branches, with harvesting of the PAC. The PAC has been measured and weighed. Twenty-nine MRI of healthy subjects have been examined to determine the volume of the PAC, the palate–pharynx distance, and epiglottis–pharynx distance.

Results

In dissection study the weight of the PAC was 18.57 g ± 2.24, the vertical dimension (height) was 4.61 cm ± 0.51, the frontal dimension (width) was 1.62 cm ± 0.24. The blood supply of the PAC constituted of branches coming from the ascending palatal and ascending pharyngeal arteries. The volume of the PAC on the right side was 1.56 cm3 ± 0.38, on the left side 1.54 cm3 ± 0.37. Its horizontal greater dimension was 1.70 cm ± 0.07.

Conclusions

There is a correlation between the volume of the PAC and the BMI in a normal population. A surgical resection of the PAC in OSAS patients by transoral robotic-assisted surgery can be proposed with preservation of the ascending palatal and ascending pharyngeal arteries.

Keywords

Parapharyngeal adipose corpus Obstructive sleep apnea syndrome Body mass index Magnetic resonance imaging Dissection 

Notes

Author contributions

PN: protocol development, data collection, data analysis, and manuscript writing. JMC: protocol development, data collection and manuscript writing. MPO: protocol development and data collection, PG: protocol development, CV: protocol development, manuscript writing and editing.

Funding

None.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest to declare.

References

  1. 1.
    Colin V, Gavid M, Timochenko A, Prades JM (2017) Le corps adipeux parapharyngé: anatomie chirurgicale et imagerie. Morphologie 101:71–76CrossRefGoogle Scholar
  2. 2.
    Godoy IRB, Martinez-Salazar EL, Eajazi A, Genta PR, Bredella MA, Torriani M (2016) Fat accumulation in the tongue is associated with male gender, abnormal upper airway patency and whole-body adiposity. Metabolism 65:1657–1663CrossRefGoogle Scholar
  3. 3.
    Horner RL, Mohiaddin DG, Lowell SA (1989) Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J 2:613–632Google Scholar
  4. 4.
    Jang MS, Kim HY, Dhong HJ, Chung SK, Hong SD, Cho HJ, Jung TY (2014) Effect of parapharyngeal fat on dynamic obstruction of the upper airway in patients with obstructive sleep apnea. Am J Respir Crit Care Med 190:1318–1321CrossRefGoogle Scholar
  5. 5.
    Kahn JL, Bourjat P (1996) La région péripharyngée: anatomie et imagerie normale. J Radiol 77:87–97Google Scholar
  6. 6.
    Kahn JL, Sick H, Laude M, Koritke JG (1987) La boule de Bichat ou corpus adiposum buccae. Arch Anat Histol Embryol Norm Exp 70:33–71Google Scholar
  7. 7.
    Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H et al (2014) Tongue fat and its relationship to obstructive sleep apnea. Sleep 37:1639–1648CrossRefGoogle Scholar
  8. 8.
    Li Y, Lin N, Ye J, Chang Q, Han D, Sperry A (2012) Upper airway fat tissue distribution in subjects with obstructive sleep apnea and its effect on retropalatal mechanical loads. Respir Care 57:1098–1105CrossRefGoogle Scholar
  9. 9.
    Mortimore I, Marshall J, Wraith PKP, Sellar R, Douglas N (1998) Neck and total body fat deposition in non-obese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 157:280–283CrossRefGoogle Scholar
  10. 10.
    Ozturk E, Dalayman D, Sonmez G, Mutlu H, Sildiroglu HO, Basekim CC, Kizilkaya E (2007) The effect of pharyngeal soft tissue components on snoring. Clin Imaging 31:259–263CrossRefGoogle Scholar
  11. 11.
    Pahkala R, Seppä J, Ikonen A, Smirnov G, Tuomilehto H (2014) The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath 18:275–282CrossRefGoogle Scholar
  12. 12.
    Shelton KE, Woodson H, Spencer G, Suratt PM (1993) Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis 148:462–466CrossRefGoogle Scholar
  13. 13.
    Schwab RJ, Gupta KB, Gefter WB, Hoffman EA, Pack AI (1995) Upper airway soft tissue anatomy in normal and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls. Am Respir Crit Care Med 152:1673–1689CrossRefGoogle Scholar
  14. 14.
    Sutherland K, Lee RWW, Philips CL, Dungan G, Yee BJ, Magnussen JS, Grunstein RR, Cistulli PA (2011) Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax 66:797–803CrossRefGoogle Scholar
  15. 15.
    White HN, Moore EJ, Rosenthal EL, Carrol WR, Olsen KD, Desmond RA et al (2010) Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: 1- and 2-year survival analysis. Arch Otolaryngol Neck Surg 136:1248CrossRefGoogle Scholar
  16. 16.
    Wolfram-Gabel R, Kahn JL, Bourjat P (1997) The parapharyngeal adipose corpus: morphologic study. Surg Radiol Anat 19:249–255Google Scholar
  17. 17.
    Young T, Peppard PE, Taheri S (2005) Excess weight and sleep-disordered breathing. J Appl Physiol 99:1592–1599CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.AnatomyUniversity Paris DiderotParisFrance
  2. 2.Department of Maxillofacial SurgeryHôpital Beaujon, APHPClichyFrance
  3. 3.RadiologyUniversity of Amiens and CHU AmiensAmiensFrance
  4. 4.Sleep Medecine, Physiology, Functional Exploration DepartmentUniversity Paris Diderot, Hôpital Bichat, APHPParisFrance
  5. 5.Department of Maxillofacial SurgerySorbonne University, Hôpital Pitié-Salpétrière, APHPParisFrance

Personalised recommendations