Department of Otolaryngology–Head and Neck Surgery, University of Western Ontario, Children’s Hospital, London Health Sciences Centre, ON.
J Otolaryngol Head Neck Surg. 2011 Apr;40(2):157-66.
To evaluate the intermediate and longer-term perceptual and objective speech outcomes in velopharyngeal insufficiency (VPI) patients treated with a superiorly based pharyngeal flap.
Retrospective review.
Tertiary care centre, London, Ontario.
Forty consecutive VPI patients (mean age 14.5 years) from 2004 to 2008 who had a first time superiorly based pharyngeal flap were included. The modified Hogan flap and lateral port control technique was used with a 70° endoscope to provide intraoperative coaxial and magnified lateral port visualization.
The American Cleft Palate-Craniofacial Association (ACPA) perceptual speech assessment and nasalance measured via nasometry using the MacKay-Kummer Simplified Nasometric Assessment Procedures Revised (SNAP-R). A comparison of mean outcomes from the pretreatment versus an intermediate (ACPA 4.3 months; SNAP-R 4.0 months) and longer-term (ACPA 19.5 months) posttreatment time point was performed, and the distribution of successful outcomes was assessed.
Mean perceptual scores improved significantly early after surgery (p < .0001; n = 33) and in the longer term (p < .01; n = 21), with high success rates for hypernasality (87.9% and 80.9%; p < .0001), audible nasal emission (90.9% and 90.5%; p < .0001), overall intelligibility (75.7% and 81.0%; p < .01), and compensatory articulation (81.8% and 85.7%; p < .01). Likewise, significant improvements were observed in posttreatment nasal (n = 38; p < .01) and mean oral SNAP-R scores (n = 39; p < .001), which demonstrated success rates of 100% (p < .0001) and 73% (p < .0001), respectively. Overcorrection was not observed in perceptual and nasometric testing.
The modified Hogan flap and lateral port control technique with the use of a 70° endoscope is highly successful in treating VPI. These results indicate that speech outcome improvement occurs early after surgery and is maintained over time.
评估使用改良的基于咽上部的咽成形术治疗咽腔闭合不全（VPI）患者的中期和长期感知和客观言语结果。
回顾性研究。
安大略省伦敦的三级护理中心。
2004 年至 2008 年期间，我们纳入了 40 例首次接受基于咽上部的咽成形术的 VPI 患者（平均年龄 14.5 岁）。使用改良的霍根瓣和侧口控制技术，结合 70°内窥镜提供术中同轴和放大的侧口可视化。
采用美国腭裂颅面协会（ACPA）感知言语评估和鼻音计通过鼻测法测量，使用 MacKay-Kummer 简化鼻测评估程序修订版（SNAP-R）。对术前与中期（ACPA 4.3 个月；SNAP-R 4.0 个月）和长期（ACPA 19.5 个月）治疗后时间点的平均结果进行比较，并评估成功结果的分布。
手术后早期（p <.0001；n = 33）和长期（p <.01；n = 21）感知评分显著提高，高鼻音（87.9%和 80.9%；p <.0001）、可闻性鼻漏（90.9%和 90.5%；p <.0001）、整体可理解度（75.7%和 81.0%；p <.01）和代偿性发音（81.8%和 85.7%；p <.01）的成功率高。同样，在治疗后的鼻测法（n = 38；p <.01）和平均口腔 SNAP-R 评分（n = 39；p <.001）中观察到显著改善，其成功率为 100%（p <.0001）和 73%（p <.0001）。在感知和鼻音计测试中没有观察到过度矫正。
使用改良的基于咽上部的咽成形术和 70°内窥镜的侧口控制技术治疗 VPI 非常成功。这些结果表明，手术后言语结果的改善很早就发生，并随着时间的推移而持续。
