D'Antonio L L, Eichenberg B J, Zimmerman G J, Patel S, Riski J E, Herber S C, Hardesty R A
School of Allied Health and the School of Medicine, Department of Surgery, Loma Linda University, Calif, USA.
Plast Reconstr Surg. 2000 Sep;106(3):539-49; discussion 550-3.
Recent studies have shown that the Furlow double-opposing Z-plasty has several advantages that make it an attractive procedure for cleft palate repair and treatment of velopharyngeal insufficiency in selected cases. The anatomic changes associated with this procedure have never been documented prospectively. The purpose of this study was to describe radiographic dimensions of the velopharynx and aerodynamic measures of velopharyngeal function in a group of patients before and after Furlow Z-plasty for the treatment of velopharyngeal insufficiency. Twelve consecutive patients with cleft palate and velopharyngeal insufficiency, ranging in age from 3 to 19 years, were selected as candidates for Furlow Z-plasty based on perceptual, endoscopic, and radiographic findings. Eight patients had repaired cleft palate with a residual muscle diastasis and four patients had unrepaired submucous cleft palate. Subjects received aerodynamic and cephalometric assessments before and after Z-plasty. Cephalometric x-rays were measured for velar length, thickness, and pharyngeal depth. Mean nasal airflow during pressure consonants (Vn) was calculated from pressure/flow studies, and patients were categorized as having complete closure (<10 cc/sec Vn) or incomplete closure (>10 cc/ sec Vn). After Z-plasty, there was a significant increase in velar length (p = 0.002) and velar thickness (p = 0.001). After surgery, patients with complete velopharyngeal closure had significantly greater velar length than the incomplete closure group (p = 0.05) with nearly twice the increase in length. Similarly, following surgery, the complete closure group had significantly greater thickness than the incomplete closure group (p = 0.01), with a greater postoperative increase in velar thickness (p = 0.005). Finally, there was a significant negative correlation between percent increase in length and percent increase in thickness for patients in the complete closure group (r = -0.91, p = 0.03). Findings demonstrate that following Furlow Z-plasty, patients with cleft palate and velopharyngeal insufficiency obtained significant increases in velar length and thickness. Greater velar length and greater velar thickness both were associated with complete velopharyngeal closure. Patients in the complete closure group tended to demonstrate large percent gains in either length or thickness or moderate gains in both. Patients in the incomplete closure group tended to demonstrate relatively small percent gains in both dimensions. Results suggest there may be important anatomic features (such as pharyngeal depth/velar length ratio) that can be evaluated before surgery to predict which patients may be most likely to benefit from Furlow Z-plasty as a form of treatment for velopharyngeal insufficiency.
近期研究表明，Furlow双反向Z成形术具有多项优势，使其成为腭裂修复及特定病例中腭咽闭合不全治疗的理想术式。此前从未对该手术相关的解剖学变化进行过前瞻性记录。本研究旨在描述一组接受Furlow Z成形术治疗腭咽闭合不全的患者术前和术后腭咽部的影像学尺寸及腭咽功能的空气动力学指标。根据语音、内镜及影像学检查结果，连续选取12例年龄在3至19岁之间的腭裂伴腭咽闭合不全患者作为Furlow Z成形术的候选对象。其中8例患者为腭裂修复术后存在残留肌肉分离，4例患者为未修复的黏膜下腭裂。研究对象在Z成形术前和术后接受了空气动力学及头影测量评估。对头影X线片测量软腭长度、厚度及咽深度。通过压力/流量研究计算出压力辅音时的平均鼻气流（Vn），并将患者分为腭咽完全闭合组（Vn<10 cc/秒）或不完全闭合组（Vn>10 cc/秒）。Z成形术后，软腭长度（p = 0.002）和软腭厚度（p = 0.001）显著增加。术后，腭咽完全闭合的患者软腭长度显著大于不完全闭合组（p = 0.05），长度增加近两倍。同样，术后完全闭合组的软腭厚度显著大于不完全闭合组（p = 0.01），软腭厚度术后增加幅度更大（p = 0.005）。最后，完全闭合组患者的长度增加百分比与厚度增加百分比之间存在显著负相关（r = -0.91，p = 0.03）。研究结果表明，Furlow Z成形术后，腭裂伴腭咽闭合不全的患者软腭长度和厚度显著增加。更大的软腭长度和更大的软腭厚度均与腭咽完全闭合相关。完全闭合组患者在长度或厚度方面往往有较大百分比的增加，或在两者方面都有适度增加。不完全闭合组患者在两个维度上的增加百分比往往相对较小。结果提示，术前可能存在重要的解剖学特征（如咽深度/软腭长度比值），可用于预测哪些患者可能最有可能从Furlow Z成形术作为腭咽闭合不全的一种治疗方式中获益。
