Hassan Mohamed E, Askar Sherif
Zagazig City, Egypt From the General Surgery Department, Pediatric Surgery Unit, and Department of Otolaryngology, Faculty of Medicine, Zagazig University.
Plast Reconstr Surg. 2007 May;119(6):1859-1865. doi: 10.1097/01.prs.0000259185.29517.79.
This study was designed to compare two-layer palatoplasty (Wardill-Kilner V-Y pushback technique) without intravelar veloplasty versus three-layer palatoplasty (Kriens technique) with intravelar veloplasty with regard to postoperative functional outcome of eustachian tube and velopharyngeal competence.
A prospective cohort study was conducted enrolling 70 patients with nonsyndromic cleft palate (except submucous type of cleft) over a period of 2 years. They were divided into two main groups according to the type of cleft palate: group A (Veau class II) included 32 patients and group B (Veau class I) included 38 patients. In each group, Wardill-Kilner palatoplasty (two-layer repair without intravelar veloplasty) versus Kriens palatoplasty (three-layer repair with intravelar veloplasty) was randomly selected for patients.
For the three-layer palatoplasty in both groups, there was a greater tendency for resolution of secretory otitis media in the early postoperative period, less time required for extrusion of the grommet tube, and a lower incidence of recurrent secretory otitis media. The incidence of postoperative velopharyngeal incompetence was greater with two-layer palatoplasty group. The incidence of palatal fistula was greater with three-layer palatoplasty.
Palatal muscle reconstruction in cleft palate patients confers better functional results regarding velopharyngeal competence and eustachian tube function. Although the overall incidence of postoperative palatal fistula is within the accepted range, the incidence of fistula is higher in the palatal muscle reconstruction subgroup. Future studies are required that include a larger number of patients.
本研究旨在比较未行腭帆内肌成形术的两层腭裂修复术（Wardill-Kilner V-Y 后推技术）与行腭帆内肌成形术的三层腭裂修复术（Kriens 技术）在咽鼓管功能和腭咽功能方面的术后功能结果。
进行了一项前瞻性队列研究，在 2 年时间里纳入了 70 例非综合征性腭裂患者（黏膜下腭裂类型除外）。根据腭裂类型将他们分为两个主要组：A 组（Veau Ⅱ 类）包括 32 例患者，B 组（Veau Ⅰ 类）包括 38 例患者。在每组中，为患者随机选择 Wardill-Kilner 腭裂修复术（未行腭帆内肌成形术的两层修复）与 Kriens 腭裂修复术（行腭帆内肌成形术的三层修复）。
两组中，对于三层腭裂修复术，术后早期分泌性中耳炎缓解的趋势更大，鼓膜切开置管拔除所需时间更短，分泌性中耳炎复发率更低。两层腭裂修复术组术后腭咽功能不全的发生率更高。三层腭裂修复术腭瘘的发生率更高。
腭裂患者的腭肌重建在腭咽功能和咽鼓管功能方面能带来更好的功能结果。虽然术后腭瘘的总体发生率在可接受范围内，但腭肌重建亚组中瘘的发生率更高。需要开展纳入更多患者的未来研究。
