Boston, Mass. From the Craniofacial Center and Department of Plastic and Oral Surgery, Children's Hospital and Harvard Medical School.
Plast Reconstr Surg. 2012 Oct;130(4):577e-584e. doi: 10.1097/PRS.0b013e318262f2e4.
The authors' purpose was to document speech outcome after cleft palate repair in patients with syndromic versus nonsyndromic Robin sequence. Results of secondary correction of velopharyngeal insufficiency using a superiorly based pharyngeal flap or double-opposing Z-palatoplasty are also reported.
Charts of patients with Robin sequence and cleft palate between 1980 and 2007 were reviewed. Data collected included date of birth, sex, syndrome/association, cleft palatal type (Veau I or II), age at palatoplasty, incidence of palatal fistula, postoperative speech assessment, videofluoroscopic results, need for secondary operation for velopharyngeal insufficiency, and type of secondary operation (pharyngeal flap or double-opposing Z-palatoplasty).
The authors identified 140 patients with Robin sequence who had palatal closure. Postoperative speech evaluation was available for 96 patients (69 percent). A syndrome or association was identified in 42 patients (30 percent). Primary palatoplasty was successful in 74 patients (77 percent); speech was characterized as competent and competent to borderline competent. The authors found a significantly higher incidence of velopharyngeal insufficiency following palatal repair for syndromic (38 percent) than nonsyndromic Robin sequence (16 percent). (p = 0.039). In patients with velopharyngeal insufficiency, competent or borderline competent speech was determined after double-opposing Z-palatoplasty (two of five patients) or pharyngeal flap (eight of 10 patients).
The rate of velopharyngeal insufficiency in syndromic Robin sequence is significantly greater than in nonsyndromic Robin sequence. The authors prefer pharyngeal flap for velopharyngeal insufficiency in patients with Robin sequence, whether syndromic or nonsyndromic, without retrognathism or signs/symptoms of obstructive sleep apnea.
作者的目的是记录有综合征和无综合征 Robin 序列的患者行腭裂修复术后的言语结果。还报告了使用基于咽上部的咽瓣或双对 Z 成形术进行二次矫正咽闭合不全的结果。
回顾了 1980 年至 2007 年间患有 Robin 序列和腭裂的患者的图表。收集的数据包括出生日期、性别、综合征/关联、腭裂类型（Veau I 或 II）、腭裂修复术年龄、腭裂瘘发生率、术后言语评估、视频荧光镜检查结果、二次治疗咽闭合不全的需要以及二次手术类型（咽瓣或双对 Z 成形术）。
作者确定了 140 例患有 Robin 序列的患者接受了腭裂修复术。96 例患者（69%）有术后言语评估结果。42 例患者（30%）存在综合征或关联。74 例患者（77%）的初次腭裂修复术成功；言语被描述为胜任和接近胜任。作者发现，有综合征的患者（38%）行腭裂修复术后发生咽闭合不全的发生率明显高于无综合征的 Robin 序列患者（16%）（p=0.039）。在有咽闭合不全的患者中，双对 Z 成形术（5 例中的 2 例）或咽瓣（10 例中的 8 例）后确定为言语能力胜任或接近胜任。
有综合征的 Robin 序列患者的咽闭合不全发生率明显高于无综合征的 Robin 序列患者。对于有或无小下颌及阻塞性睡眠呼吸暂停症状/体征的 Robin 序列患者，作者倾向于在咽闭合不全时使用咽瓣，而无论是否有综合征。
