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ARTICLES: J. S. Kim, S. Y. Moon, K. -D. Choi, J. -H. Kim, and J. A. Sharpe Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations Neurology 2007; 68: 1128-1135 [Abstract] [Full text] [PDF]

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Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations

Craig E. Watson   (3 August 2007)

Reply from the authors

James A. Sharpe MD, FRCPC, Ji Soo Kim, MD   (3 August 2007)

Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations 3 August 2007
Craig E. Watson, Departments of Neurology and Anatomy; Wayne State University School of Medicine 8D-UHC; 4201 St. Antoine; Detroit, MI 48201 USA Send Correspondence to journal: Re: Patterns of ocular oscillation in oculopalatal tremor: Imaging correlations crwatson{at}med.wayne.edu Craig E. Watson	We read the excellent article on oculopalatal tremor by Kim et al. [1] The authors state that "PT is generated by rhythmic contraction of the levator veli palatini, innervated from the nucleus ambiguus by the facial or glossopharyngeal nerve." The levator veli palatini muscle does receive its innervation from the nucleus ambiguus, but by way of the vagus nerve. Some authors feel that the fibers supplying the muscle actually arise from the cranial part of the accessory nerve and find their way to the levator along with the vagus after joining that nerve just distal to the jugular foramen. The facial nerve's special visceral efferent fibers arise from the facial nucleus and supply the muscles of facial expression, plus a few others. The glossopharyngeal nerve supplies only one skeletal muscle, the stylopharyngeus. References 1. Kim JS, Moon SY, Choi K-D, Kim J-H, Sharpe JA. Patterns of ocular oscillation in oculopalatal tremor: imaging correlations. Neurology 2007;68:1128-1135. Disclosure: The author reports no conflicts of interest.
Reply from the authors 3 August 2007
James A. Sharpe MD, FRCPC, University of Toronto 399 Bathurst St. , Toronto ON M5T 2S8, Ji Soo Kim, MD Send Correspondence to journal: Re: Reply from the authors James.Sharpe{at}uhn.on.ca James A. Sharpe MD, FRCPC, et al.	We thank Dr. Watson for drawing attention to the dictum that the glossopharyngeal (IXth) nerve supplies only one muscle, the stylopharyngeus, as also taught by our former distinguished Professor of Anatomy, J.C. Boileau Grant. [2] Dr. Watson states that the levator veli palatini muscle (LVP) receives its innervation from the vagus but not from the facial or IXth cranial nerves. However, in agreement with our article [1], further anatomical evidence indicates otherwise. In monkeys, the LVP is innervated by the facial nerve through its greater petrosal branch. [3] Study of human fetuses and embryos reveals that the LVP is innervated by the IXth, but not the vagus, nerve. [4] There is anatomical variation. Dissection of adult human cadavers has shown that the LVP receives its motor supply from the IXth nerve in some humans, the IX and the vagus nerves in others, and from the vagus in others. [5] Motoneurons to the LVP are located in the nucleus ambiguus bilaterally as well as in the ipsilateral retrofacial nucleus, but not in the facial nerve nucleus. [6] The bilateral innervation of the LVP by from the nucleus ambiguus may account for our observation that most of our patients with symmetrical palatal tremor had unilateral pseudohypertophy of the inferior olivary nucleus in keeping with predominantly unilateral damage to the brainstem tegmentum. [1] References 2. Grant JCB. An Atlas of Anatomy. Williams and Wilkins Baltimore, 1956 3. Ibuki K, Matsuya T, Nishio J, Hamamura Y, Miyazaki T. The course of facial nerve innervation for the levator veli palatini muscle. Cleft Palate Journal. 1978; 15:209-214. 4. Domenech-Ratto, G. Development and peripheral innervation of the palatal muscles. Acta Anatomica. 1977; 97:4-14. 5. Shimokawa T, Yi S-Q, Izumi A, et al. An anatomical study of the levator veli palatini and superior constrictor with special reference to their nerve supply. Surgical & Radiologic Anatomy. 2004; 26:100-105. 6. Keller JT, Saunders MC, van Loveren H, Shipley MT. Neuroanatomical considerations of palatal muscles: tensor and levator veli palatini. Cleft Palate Journal. 1984; 21:70-75. Disclosure: The authors report no conflicts of interest.