Lypka Michael, Bidros Rafi, Rizvi Murtaza, Gaon Mark, Rubenstein Adam, Fox Donna, Cronin Ernest
Cronin and Brauer Cleft Clinic, St. Joseph Medical Center, Houston, TX, USA.
Ann Plast Surg. 2010 Jul;65(1):48-51. doi: 10.1097/SAP.0b013e3181c1fec6.
Velopharyngeal insufficiency (VPI) remains a common problem in the care of patients with cleft palate and other related conditions. It may be successfully corrected with augmentation of the posterior pharynx. The purpose of this study was to review the experience and results of posterior pharyngeal augmentation over a 40-year period at one cleft center in the United States.
All patients from 1968 to 2008 who underwent posterior pharyngeal augmentation for the treatment of VPI were reviewed retrospectively. Diagnosis, age at the time of operation, type of implant used, duration of follow-up, speech performance both pre- and postoperatively, and complications were analyzed. Speech performance preoperatively was assessed by video fluoroscopy and/or nasoendoscopy. Resonance was assessed by both the surgeon and speech pathologist using a 4 point grading scale.
One hundred eleven patients underwent posterior pharyngeal augmentation. Thirteen patients required removal of the implant because of extrusion (n = 12) or postoperative sleep apnea (n = 1). Five patients with failed implants at the primary operation had successful replacement at a second operation, resulting in a retained implant success rate of 93%. Of the 103 patients who were successfully augmented, 15 were lost to follow-up, leaving 88 patients with full postoperative speech evaluations. Of the 88 patients evaluated, 64 exhibited normal or near normal speech (73%), 22 patients had mildly nasal speech (25%), and 2 patients (2%) were not improved. Highest extrusion rates were seen for smooth surface silicone and rolled gortex implants.
Augmentation of the posterior pharyngeal wall is a safe and effective treatment for patients with VPI. Implants are well tolerated and speech is substantially improved.
腭咽闭合不全（VPI）仍是腭裂及其他相关疾病患者治疗中常见的问题。通过增加咽后壁可成功矫正该问题。本研究的目的是回顾美国一家腭裂治疗中心40年间咽后壁增加术的经验和结果。
回顾性分析1968年至2008年间所有因治疗VPI而接受咽后壁增加术的患者。分析诊断、手术时年龄、所用植入物类型、随访时间、术前和术后语音表现以及并发症。术前语音表现通过视频透视和/或鼻内镜检查进行评估。外科医生和言语病理学家均使用4分制分级量表评估共鸣情况。
111例患者接受了咽后壁增加术。13例患者因植入物挤出（n = 12）或术后睡眠呼吸暂停（n = 1）需要取出植入物。5例初次手术植入物失败的患者在二次手术时成功更换，植入物保留成功率为93%。在103例成功增加咽后壁的患者中，15例失访，剩余88例患者进行了完整的术后语音评估。在接受评估的88例患者中，64例语音正常或接近正常（73%），22例患者有轻度鼻音（25%），2例患者（2%）无改善。光滑表面硅胶和卷状戈尔特斯植入物的挤出率最高。
咽后壁增加术是治疗VPI患者的一种安全有效的方法。植入物耐受性良好，语音有显著改善。
