Lam Eugene, Hundert Sharon, Wilkes Gordon H
Edmonton, Alberta, Canada From the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, and Department of Speech Pathology and Audiology, Stollery Children's Hospital, University of Alberta, WC Mackenzie Health Science Center.
Plast Reconstr Surg. 2007 Aug;120(2):495-505. doi: 10.1097/01.prs.0000267438.18295.e4.
After primary palatoplasty, patients with cleft palate may still require secondary surgical procedures to correct residual velopharyngeal incompetence. This study evaluated speech outcomes of patients who underwent differential velopharyngeal surgery based on degree of lateral pharyngeal wall movement and velar movement.
In this retrospective cohort study, 31 patients with cleft palate from 1992 to 2003 underwent tailor-made velopharyngeal surgery with complete preoperative and postoperative speech assessments. All patients were evaluated postoperatively for velopharyngeal incompetence resolution, persistent velopharyngeal incompetence, and hyponasality.
Velopharyngeal incompetence was resolved in 90 percent of patients. Severe hyponasality occurred as a complication in 16 percent, requiring subsequent division of the pharyngeal flap. Patients with lateral pharyngeal wall movement greater than 25 percent had a significantly greater chance of incompetence resolution compared with those with lateral pharyngeal wall movement less than 25 percent (p < 0.001). Regarding combined lateral pharyngeal wall movement plus velar movement, all groups showed significantly lower velopharyngeal competence scores following surgery (p < 0.001). Patients with lateral pharyngeal wall movement less than 25 percent and velar movement greater than 50 percent had the least successful speech outcome. The data also showed that various types of surgical operations performed on patients with similar combined degrees of lateral pharyngeal wall movement and velar movement can result in equally successful speech outcomes. This finding indicated flexibility in following the treatment algorithm for tailoring velopharyngeal surgery.
The degree of lateral pharyngeal wall movement and velar movement, rather than type of surgical procedure chosen, is a more important determinant of velopharyngeal incompetence resolution in patients with cleft palate.
腭裂患者在一期腭裂修复术后，可能仍需要二期手术来纠正残留的腭咽闭合不全。本研究评估了根据咽侧壁运动程度和腭部运动程度进行差异性腭咽手术的患者的语音结果。
在这项回顾性队列研究中，1992年至2003年的31例腭裂患者接受了定制的腭咽手术，并在术前和术后进行了全面的语音评估。所有患者术后均接受腭咽闭合不全解决情况、持续性腭咽闭合不全和鼻音不足的评估。
90%的患者腭咽闭合不全得到解决。16%的患者出现严重鼻音不足并发症，需要随后进行咽瓣分离。咽侧壁运动大于25%的患者与咽侧壁运动小于25%的患者相比，腭咽闭合不全得到解决的几率显著更高（p < 0.001）。关于咽侧壁运动加腭部运动的联合情况，所有组术后腭咽功能评分均显著降低（p < 0.001）。咽侧壁运动小于25%且腭部运动大于50%的患者语音结果最差。数据还表明，对咽侧壁运动和腭部运动联合程度相似的患者进行的各种手术操作，可产生同样成功的语音结果。这一发现表明在遵循定制腭咽手术的治疗方案时具有灵活性。
对于腭裂患者，咽侧壁运动程度和腭部运动程度而非所选择的手术类型，是腭咽闭合不全解决情况的更重要决定因素。
