Ysunza Antonio, Pamplona Carmen, Ramírez Elena, Molina Fernando, Mendoza Mario, Silva Andres
Cleft Palate Clinic, Hospital Gea Gonzalez, Mexico City, Mexico.
Plast Reconstr Surg. 2002 Nov;110(6):1401-7. doi: 10.1097/01.PRS.0000029349.16221.FB.
Residual velopharyngeal insufficiency after palatal repair varies from 10 to 20 percent in most centers. Secondary velopharyngeal surgery to correct residual velopharyngeal insufficiency in patients with cleft palate is a topic frequently discussed in the medical literature. Several authors have reported that varying the operative approach according to the findings of videonasopharyngoscopy and multiview videofluoroscopy significantly improved the success of velopharyngeal surgery. This article compares two surgical techniques for correcting residual velopharyngeal insufficiency, namely pharyngeal flap and sphincter pharyngoplasty. Both techniques were carefully planned according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. Fifty patients with cleft palate and residual velopharyngeal insufficiency were randomly divided into two groups: 25 in group 1 and 25 in group 2. Patients in group 1 were operated on by using a customized pharyngeal flap according to the findings of videonasopharyngoscopy and multiview videofluoroscopy in each case. Those in group 2 received a sphincter pharyngoplasty also customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients in both groups was not significantly different (p > 0.5). The frequency of residual velopharyngeal insufficiency after the individualized velopharyngeal surgery was not significantly different between the patient groups (12 percent versus 16 percent; p > 0.05). It seems that customized pharyngeal flaps and sphincter pharyngoplasties performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy are safe and reliable procedures for treating residual velopharyngeal insufficiency in cleft palate patients.
在大多数医疗中心，腭裂修复术后腭咽闭合不全的残留率在10%至20%之间。针对腭裂患者残留的腭咽闭合不全进行二次腭咽手术是医学文献中经常讨论的话题。几位作者报告称，根据鼻咽喉镜检查和多视角电视透视检查结果改变手术方法，可显著提高腭咽手术的成功率。本文比较了两种纠正残留腭咽闭合不全的手术技术，即咽瓣手术和腭咽括约肌成形术。这两种技术均根据鼻咽喉镜检查和多视角电视透视检查结果精心设计。50例腭裂并伴有残留腭咽闭合不全的患者被随机分为两组：第1组25例，第2组25例。第1组患者根据每次的鼻咽喉镜检查和多视角电视透视检查结果，采用定制的咽瓣进行手术。第2组患者则接受同样根据鼻咽喉镜检查和多视角电视透视检查结果定制的腭咽括约肌成形术。两组患者的年龄中位数无显著差异（p>0.5）。两组患者在个体化腭咽手术后残留腭咽闭合不全的发生率无显著差异（分别为12%和16%；p>0.05）。根据鼻咽喉镜检查和多视角电视透视检查结果进行定制的咽瓣手术和腭咽括约肌成形术，似乎是治疗腭裂患者残留腭咽闭合不全的安全可靠方法。
