Ysunza Antonio, Pamplona Maria Carmen, Molina Fernando, Drucker Mónica, Felemovicius Jacobo, Ramírez Elena, Patiño Carmeluza
Hospital Gea Gonzalez, 4800 Calzada Tlalpan, Mexico D.F. 14000, Mexico.
Int J Pediatr Otorhinolaryngol. 2004 Dec;68(12):1499-505. doi: 10.1016/j.ijporl.2004.06.010.
Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality.
This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy.
Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy.
There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients.
Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.
上蒂咽瓣和咽括约肌成形术是腭咽功能不全导致的高鼻音外科治疗的两种主要术式。鼻咽喉镜检查和多视角电视透视吞咽功能检查可为这些纠正高鼻音的外科手术规划提供解剖学和生理学数据。
本研究旨在评估咽瓣和咽括约肌成形术纠正腭咽闭合不全的手术规划及效果。手术技术根据鼻咽喉镜检查和多视角电视透视吞咽功能检查结果进行定制。
对70例腭裂修复术后存在腭咽功能障碍的患者进行研究。患者被随机分为两组。第一组接受咽瓣手术。第二组接受咽括约肌成形术。两种手术均根据鼻咽喉镜检查和多视角电视透视吞咽功能检查结果进行个体化定制。
两组患者术前腭咽闭合间隙的平均大小无显著差异（P>0.05）（均值=27.5%；标准差=7.7%，与均值=28.3%；标准差=5.9%）。术后，第一组89%的病例和第二组85%的病例腭咽功能障碍得到完全纠正。两组患者纠正腭咽闭合不全的成功率无显著差异（P>0.05）。
咽瓣和咽括约肌成形术似乎是治疗残留腭咽功能障碍的安全可靠术式。虽然本文研究的并非所有患者术后都实现了完全闭合，但所有患者的腭咽闭合缺损大小均有所减小。为使术后结构与通过鼻咽喉镜检查和电视透视吞咽功能检查所观察到的术前腭咽尺寸及运动相匹配而进行的手术规划，似乎是纠正残留腭咽功能障碍手术中最重要的方面。
