Quebec University Hospital Center (CHUQ), Quebec City, Quebec, Canada.
Laryngoscope. 2014 Feb;124(2):561-9. doi: 10.1002/lary.24200. Epub 2013 Aug 5.
OBJECTIVES/HYPOTHESIS: To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
Retrospective cohort study.
Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two-flap palatoplasty for cleft lip-palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech-language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 - b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 - b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2-5.1, sensitivity = 72%-81%, P < .03).
The width of the cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 - b1).
目的/假设：找到预测腭裂修复后咽鼓管功能不全（VPI）发生的腭裂解剖测量值（或计算参数）。
回顾性队列研究。
对接受 Von Langenbeck 技术行单纯腭裂修复术或 Bardach 双瓣腭裂修复术的腭裂患者的图表进行了回顾。在腭裂修复术中前瞻性测量了 7 个解剖腭裂参数。三位盲法语音语言病理学家回顾性地在 4 岁时对临床评估的 VPI 进行评分。咽成形术的建议也被用作 VPI 的指标。
1993 年至 2008 年，共有 67 名患者入组研究。最佳预测参数为 a/(30-b1)比值，其中 a 定义为软腭与后咽壁之间的后间隙，b1 为硬腭水平的裂隙宽度。a/(30-b1)比值>0.7 至 0.8 与发生 VPI 的风险较高相关（相对风险 2.2-5.1，敏感性 72%-81%，P<.03）。
硬腭水平裂隙宽度和软腭与后咽壁之间的后间隙是预测 VPI 的最重要参数。a/(30-b1)比值相关性最佳。
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