The uvula is of course the little piece of flesh that hangs down from the rear portion of the soft palate. It is formed during development as the last step of fusion of the two halves of the soft palate, as it "zips up" from front to back.

Because of the way the uvula forms, it can have several variations of appearance. The uvula ordinarily appears to be a solid cylinder of tissue. This cylinder may show a groove that divides one side of the cylinder from the other. This reflects the fact that the two halves of tissue joined but only partially fused.

More intriguing to see are uvulas that appear to be an upside down "Y," that is, partially split at the lower end. Rarely, the uvula is completely split from top to bottom, and hangs as two parts. Such a finding would alert me to check for a submucous cleft palate, especially before clearing a child for an adenoidectomy.

I have seen bacterial infection of the uvula alone; this is very rare, especially compared to the incidence of inflammation of the uvula from Group A streptococcal infection ("strep throat"). If the infection is not caused by Streptococcus, it is probably caused by a Staphylococcus infection. Massive enlargement of the infected uvula can potentially cause respiratory obstruction.

But ordinarily, the uvula remains out of sight, out of mind.

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