ORL-HN Surgery Department, Faculty of Medicine, Zagazig University Hospitals, Zagazig University, (8) Kamal Abaza Street, Zagazig, Sharkia Governorate, Egypt,
Eur Arch Otorhinolaryngol. 2014 Feb;271(2):391-8. doi: 10.1007/s00405-013-2572-3. Epub 2013 Jun 6.
Both sphincter pharyngoplasty (SP) and pharyngeal flap (PF) procedures have gained popularity among surgeons as effective surgical management for velopharyngeal insufficiency (VPI). Different centers prefer either SP or PF and have published their results to support this preference. But is one technique superior to the other? To answer this question, we have adopted the concept of differential therapeutic management, based on detailed assessment of velopharyngeal function. According to this assessment either SP or PF was performed for management of VPI (secondary to adenotonsillectomy). The aim of this work is to evaluate and compare the surgical results after SP and PF (based on the preoperative nasoendoscopy and phoniatrics' evaluation). This study was conducted on 31 patients with persistent hypernasality after adenotonsillectomy. All patients were subjected to perceptual speech evaluation and nasoendoscopic examination. According to this evaluation and data analysis, 18 patients were operated by SP and 13 patients underwent PF. Statistically, highly significant improvements were found when comparing pre- versus postoperative perceptual speech evaluation following both SP and PF (P < 0.001). When comparing the postoperative perceptual speech evaluation following both techniques, statistically non-significant differences were reported (P > 0.05). Preoperative differential diagnosis of VPI using perceptual speech assessment and nasoendoscopy of the velopharynx allows for tailored surgical management with either SP or PF. Both SP and PF procedures could yield good surgical outcomes, when patients are properly selected and the technique is chosen according to preoperative assessment.
咽成形术（SP）和咽瓣（PF）手术均已成为治疗腭咽闭合不全（VPI）的有效手术方法，受到外科医生的青睐。不同的中心倾向于使用 SP 或 PF，并发表了他们的结果来支持这种偏好。但是，一种技术是否优于另一种技术？为了回答这个问题，我们采用了基于详细评估腭咽功能的差异化治疗管理概念。根据这种评估，对于 VPI（继发于腺样体切除术）的管理，要么进行 SP，要么进行 PF。本工作的目的是评估和比较 SP 和 PF 后的手术结果（基于术前鼻内镜和语音学评估）。这项研究共纳入了 31 例腺样体切除术后继发持续鼻音过高的患者。所有患者均接受了感知语音评估和鼻内镜检查。根据这项评估和数据分析，18 例患者行 SP，13 例患者行 PF。统计学分析显示，SP 和 PF 后感知语音评估的术前与术后比较均有显著改善（P<0.001）。比较两种技术的术后感知语音评估时，报告差异无统计学意义（P>0.05）。使用感知语音评估和腭咽的鼻内镜对 VPI 进行术前鉴别诊断，可根据患者的具体情况选择 SP 或 PF 进行针对性的手术治疗。当患者选择合适并根据术前评估选择技术时，SP 和 PF 手术均可获得良好的手术效果。
