Hens G, Sell D, Pinkstone M, Birch M J, Hay N, Sommerlad B C, Kangesu L
Cleft Palate Craniofac J. 2013 Sep;50(5):e84-91. doi: 10.1597/11-211. Epub 2012 Dec 13.
OBJECTIVE : To assess the outcome of palate lengthening by myomucosal buccinator flaps for velopharyngeal insufficiency both in terms of speech and changes in palate length. DESIGN : Thirty-two consecutive patients who underwent the buccinator flap procedure were reviewed retrospectively. Palate length and the presence or absence of a velopharyngeal gap were assessed on pre- and postoperative videofluoroscopic recordings using a calibrated image analysis system. Hypernasality, nasal emission, nasal turbulence, and passive cleft type articulation errors were evaluated blindly by a speech-language pathologist external to the team using pre- and postoperative speech recordings. SETTING : Multidisciplinary cleft team based in a tertiary referral center. Results : In 81% of patients, speech outcome was such that no further velopharyngeal surgery was considered necessary at the time of follow-up. The buccinator flap procedure resulted in a mean palate lengthening of 7.5 mm (±5.5 SD). After the operation, there was a complete elimination of the velopharyngeal gap on lateral videofluoroscopy in 77% of patients. There were significant decreases in hypernasality ratings and passive cleft type articulation errors postoperatively.
Palatal lengthening with myomucosal buccinator flaps in patients with velopharyngeal insufficiency is effective and safe. It has become one of our routinely practiced procedures for velopharyngeal insufficiency.
目的：从语音及腭长度变化方面评估使用颊肌黏膜瓣进行腭延长术治疗腭咽闭合不全的效果。设计：对连续32例行颊肌黏膜瓣手术的患者进行回顾性研究。使用校准图像分析系统，根据术前和术后的视频荧光造影记录评估腭长度以及腭咽间隙的有无。由团队外的言语病理学家通过术前和术后的语音记录，对高鼻音、鼻漏气、鼻湍流及被动腭裂型发音错误进行盲法评估。地点：位于三级转诊中心的多学科腭裂治疗团队。结果：81%的患者语音结果显示，随访时无需进一步进行腭咽手术。颊肌黏膜瓣手术使腭平均延长7.5毫米（标准差±5.5）。术后，77%的患者在侧位视频荧光造影中腭咽间隙完全消失。术后高鼻音评分及被动腭裂型发音错误显著减少。
对于腭咽闭合不全患者，使用颊肌黏膜瓣进行腭延长术有效且安全。它已成为我们治疗腭咽闭合不全的常规手术之一。
