The palatopharyngeus forms the posterior tonsillar pillar, running from the soft palate posterolaterally to the pharyngeal wall and thyroid cartilage. During swallowing it elevates the pharynx, closes the nasopharyngeal isthmus with the levator veli palatini, and assists in laryngeal elevation. It is broader and thicker than the palatoglossus (anterior pillar).
| Origin | Soft palate (palatine aponeurosis) from two muscular fascicles that encircle the musculus uvulae |
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| Insertion | Posterior border of the thyroid cartilage and the lateral pharyngeal wall (blending with the inferior pharyngeal constrictor and the stylopharyngeus) |
| Nerve Supply | Vagus nerve (CN X) via the pharyngeal plexus |
| Blood Supply | Ascending palatine artery and minor palatine artery |
| Actions | Depresses the soft palate; elevates the larynx and pharynx during swallowing; narrows the oropharyngeal isthmus; forms the posterior tonsillar pillar |
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The palatopharyngeus is directly relevant to OSA surgery: uvulopalatopharyngoplasty (UPPP) trims the posterior tonsillar pillar (palatopharyngeus) to widen the oropharyngeal airway. The muscle contributes to velopharyngeal competence and its aggressive resection produces velopharyngeal insufficiency (VPI) with nasal regurgitation and hypernasal speech. Pharyngoplasty techniques (Orticochea, sphincter pharyngoplasty) use palatopharyngeus flaps rotated to the posterior pharyngeal wall to create a dynamic velopharyngeal sphincter for VPI correction.
Over-aggressive resection of the palatopharyngeus during UPPP produces velopharyngeal insufficiency with hypernasal speech and nasal regurgitation of liquids; sphincter pharyngoplasty using residual palatopharyngeus flaps reconstructs the velopharyngeal valve and corrects the iatrogenic VPI.
