Perkins Jonathan A, Lewis Charlotte W, Gruss Joseph S, Eblen Linda E, Sie Kathleen C Y
Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Plast Reconstr Surg. 2005 Jul;116(1):72-80; discussion 81-4. doi: 10.1097/01.prs.0000169694.29082.69.
The objectives of the study were to describe speech outcomes in a large series of patients undergoing Furlow palatoplasty for management of velopharyngeal insufficiency and to test whether preoperative velopharyngeal gap size and other patient characteristics significantly affect those outcomes.
Data collected included age at the time of surgery, surgeon, type of cleft, syndrome diagnosis, preoperative velopharyngeal gap size as determined by videonasendoscopy, and preoperative and postoperative perceptual speech assessments. Descriptive statistics were generated and ordinal logistic regression on the outcome variable, postoperative velopharyngeal insufficiency severity score, was performed.
In this series of 154 patients, 148 had complete perceptual speech data. Of these 148 patients, 72 percent had improvement in velopharyngeal insufficiency severity after the procedure and 56 percent had complete resolution of velopharyngeal insufficiency. Postoperative insufficiency was scored as none or minimal (i.e., resolution) in 38 of 52 patients (73 percent) with a small preoperative velopharyngeal gap, 26 of 51 patients (51 percent) with a moderate preoperative gap, and four of 21 patients (19 percent) with a large preoperative gap. Preoperative velopharyngeal gap size was significantly associated (p < 0.0001) with postoperative insufficiency on ordinal multivariate logistic regression after controlling for preoperative insufficiency and other covariates. There was not a significant association between syndrome diagnosis, age at Furlow palatoplasty (younger than 5 years versus older), gender, surgeon, or presence of submucous cleft palate and postoperative speech outcome, in either the unadjusted or adjusted analyses.
Preoperative velopharyngeal gap size, as determined with nasendoscopy, was significantly associated with postoperative velopharyngeal insufficiency severity after Furlow palatoplasty. Small gap size is associated with a greater likelihood of resolution.
本研究的目的是描述大量接受Furlow腭成形术治疗腭咽闭合不全患者的语音结果，并测试术前腭咽间隙大小和其他患者特征是否显著影响这些结果。
收集的数据包括手术时的年龄、外科医生、腭裂类型、综合征诊断、经鼻内镜检查确定的术前腭咽间隙大小以及术前和术后的语音感知评估。生成描述性统计数据，并对结果变量术后腭咽闭合不全严重程度评分进行有序逻辑回归分析。
在这154例患者中，148例有完整的语音感知数据。在这148例患者中，72%的患者术后腭咽闭合不全严重程度有所改善，56%的患者腭咽闭合不全完全缓解。术前腭咽间隙小的52例患者中有38例（73%）术后无或仅有轻微闭合不全（即缓解），术前腭咽间隙中等的51例患者中有26例（51%），术前腭咽间隙大的21例患者中有4例（19%）。在控制术前闭合不全和其他协变量后，术前腭咽间隙大小与术后闭合不全在有序多变量逻辑回归中显著相关（p<0.0001）。在未调整或调整分析中，综合征诊断、Furlow腭成形术时的年龄（5岁以下与5岁以上）、性别、外科医生或黏膜下腭裂的存在与术后语音结果之间均无显著关联。
经鼻内镜检查确定的术前腭咽间隙大小与Furlow腭成形术后腭咽闭合不全严重程度显著相关。间隙小与缓解的可能性更大相关。
