Annigeri Venkatesh M, Mahajan Jai K, Nagarkar Anu, Singh Satinder P
Department of Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Indian Assoc Pediatr Surg. 2012 Oct;17(4):157-61. doi: 10.4103/0971-9261.102333.
To analyse the factors affecting clinical and functional outcome of Veau-Wardill-Kilner palatoplasty in various types of cleft palate.
Demographic data were retrieved from case records and a detailed speech, language and hearing and an orthodontic analysis were carried out prospectively.
Mean age at operation was 2.7 years; whereas mean age at the time of evaluation was 6 years. Most of the patients (43.3%, 13/30) had a bilateral cleft lip and palate. The postoperative fistula had developed in 31% (4/13) of the patients with bilateral clefts and in 17% (1/6) and 9% (1/11) of the patients with left unilateral and isolated cleft palate respectively (P<0.05). Eight per cent (2/24) of the patients operated before 2 years of age developed a fistula as compared to 66.6% (4/6) of the patients who had undergone a repair after 2 years of age (P<0.01). Severe speech abnormality was seen in 33.4% of the patients having postoperative fistula as compared to 16.6% of non-fistula patients (P<0.05). Derangement of speech was found in 66.6% of the patients who had undergone surgery after the age of 2 years as compared to the patients (13%, 3/24) undergoing correction before 2 years of age (P<0.05). Hearing loss was seen most commonly in patients with bilateral cleft palate as compared to the other varieties (P>0.05). Tympanic membrane (TM) abnormalities were also more common in bilateral cleft patients (P<0.05). Mean maxillary arch length, arch circumference and maxillary inter-canine and inter-molar width were significantly reduced as compared to the control group (P<0.001).
Socially acceptable quality of speech can be achieved in more than 85% of the patients. The postoperative fistula is associated with poor speech; bilateral cleft and older age being the risk factors for fistula formation. Many patients require audiological surveillance even when asymptomatic. Maxillary growth is impaired in all the patients despite early surgery.
分析不同类型腭裂行韦氏-瓦迪尔-基尔纳腭裂修复术时影响临床及功能预后的因素。
从病例记录中获取人口统计学数据，并前瞻性地进行详细的言语、语言及听力以及正畸分析。
手术平均年龄为2.7岁；而评估时的平均年龄为6岁。大多数患者（43.3%，13/30）为双侧唇腭裂。双侧腭裂患者中有31%（4/13）出现术后瘘管，左侧单侧腭裂和孤立性腭裂患者中分别有17%（1/6）和9%（1/11）出现术后瘘管（P<0.05）。2岁前接受手术的患者中有8%（2/24）出现瘘管，而2岁后接受修复手术的患者中有66.6%（4/6）出现瘘管（P<0.01）。有术后瘘管的患者中33.4%出现严重言语异常，而非瘘管患者中这一比例为16.6%（P<0.05）。2岁后接受手术的患者中有66.6%出现言语紊乱，而2岁前接受矫正手术的患者中这一比例为13%（3/24）（P<0.05）。与其他类型相比，双侧腭裂患者中听力损失最为常见（P>0.05）。鼓膜（TM）异常在双侧腭裂患者中也更为常见（P<0.05）。与对照组相比，平均上颌弓长度、弓周长以及上颌尖牙间和磨牙间宽度显著减小（P<0.001）。
超过85%的患者可获得社会可接受的言语质量。术后瘘管与言语不佳相关；双侧腭裂和年龄较大是瘘管形成的危险因素。许多患者即使无症状也需要听力监测。尽管早期手术，但所有患者的上颌生长均受到损害。
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