Abdel-Aziz Mosaad
Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt.
Int J Pediatr Otorhinolaryngol. 2008 Feb;72(2):173-7. doi: 10.1016/j.ijporl.2007.10.004. Epub 2007 Nov 26.
(a) Pharyngeal flap and sphincter pharyngoplasty are the procedures most frequently chosen by craniofacial surgeons for surgical management of velopharyngeal insufficiency. Both operations may be complicated by obstructive breathing and even sleep apnea. (b) The purpose of this study is to evaluate the efficacy of a palatopharyngeal sling in the treatment of velopharyngeal insufficiency in cases with weak palatal mobility and its effect on breathing.
Seventeen cases of post-palatoplasty velopharyngeal insufficiency were subjected to treatment by palatopharyngeal sling. This sling, created by elevation of bilateral myomucosal flaps formed of palatopharyngeus and superior constrictor muscles, passed through palatal split, sutured together and to a raw area on the oral surface of the soft palate. Pre- and post-operative evaluation was carried out by perceptual speech analysis and flexible nasopharyngoscopy. Polysomnography was used to assess the effect of the operation on breathing.
Complete closure was achieved in 13 cases (76.5%) while 4 cases showed incomplete closure (2 of them showed improvement when compared with the pre-operative video). The overall improvement of speech and velopharyngeal closure was 88.2%. Polysomnography showed no obstructive breathing.
Palatopharyngeal sling is a useful technique for correction of velopharyngeal insufficiency in cases with little palatal motion and it carries no risk of obstructive sleep apnea.
（a）咽瓣术和咽括约肌成形术是颅面外科医生治疗腭咽闭合不全最常选用的手术方法。这两种手术都可能并发呼吸阻塞甚至睡眠呼吸暂停。（b）本研究的目的是评估腭咽吊带术治疗腭运动无力型腭咽闭合不全的疗效及其对呼吸的影响。
对17例腭裂术后腭咽闭合不全患者采用腭咽吊带术治疗。该吊带由腭咽肌和咽上缩肌形成的双侧肌黏膜瓣掀起后，经腭部裂隙穿过，缝合在一起并固定于软腭口腔面的创面上。术前和术后通过语音感知分析和可弯曲鼻咽镜进行评估。采用多导睡眠图评估手术对呼吸的影响。
13例（76.5%）实现完全闭合，4例闭合不全（其中2例与术前视频相比有改善）。语音和腭咽闭合的总体改善率为88.2%。多导睡眠图显示无呼吸阻塞。
腭咽吊带术是治疗腭运动很少的腭咽闭合不全的一种有效技术，且无阻塞性睡眠呼吸暂停的风险。
