Metzler Philipp, Low David W, Mundinger Gerhard S, Steinbacher Derek M
Craniofacial Fellow, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
Professor, Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
J Oral Maxillofac Surg. 2014 Apr;72(4):803.e1-6. doi: 10.1016/j.joms.2013.11.027. Epub 2013 Dec 6.
Strategies to address severe anteroposterior palatal shortening with velopharyngeal insufficiency include palatal lengthening or manipulation of posterior pharyngeal tissue as a flap or sphincter. In some cases, a single procedure alone is not sufficient to achieve dynamic velopharyngeal closure. The objective of this study was to determine whether double-opposing Z-plasty coupled with a posterior pharyngeal flap would achieve adequate palatal length in severe velopharyngeal dysfunction.
Six patients, 3 with previously unrepaired cleft palate and 3 children with previous straight-line repairs and significant anteroposterior shortening, were included. Demographic and perioperative information was tabulated. Subjective and objective speech data were gathered, if available. Complications, follow-ups, and postoperative nasometric results were compiled. Statistical analysis involved the paired t test.
There were no perioperative complications. Follow-up was at least 1 year. No postoperative fistulas or nasal obstruction developed. Hypernasal speech and nasal emission were subjectively improved in all patients. Nasometric data showed a statistically significant improvement in nasal air escape with speech.
Simultaneous double-opposing Z-plasty and posterior pharyngeal flap can be performed effectively. This strategy is useful for severe velopharyngeal dysfunction secondary to anteroposterior palatal shortening or a previously unrepaired cleft palate, and the technique optimizes palatal function and creates a mechanical blockade to nasal air escape.
解决伴有腭咽闭合不全的严重腭前后径缩短的策略包括腭延长术或对咽后组织进行瓣或括约肌样的处理。在某些情况下，单一手术不足以实现动态腭咽闭合。本研究的目的是确定双反向Z成形术联合咽后瓣是否能在严重腭咽功能障碍中实现足够的腭长度。
纳入6例患者，其中3例为既往未修复的腭裂患者，3例为既往行直线修复且存在明显前后径缩短的儿童。将人口统计学和围手术期信息制成表格。如有可用数据，收集主观和客观语音数据。汇总并发症、随访情况及术后鼻音测量结果。统计分析采用配对t检验。
围手术期无并发症发生。随访至少1年。术后未出现瘘管或鼻塞。所有患者的高鼻音语音和鼻漏气主观上均有改善。鼻音测量数据显示，语音时鼻气逸出在统计学上有显著改善。
双反向Z成形术和咽后瓣可同时有效施行。该策略对继发于腭前后径缩短或既往未修复腭裂的严重腭咽功能障碍有用，且该技术可优化腭功能并对鼻气逸出形成机械性阻塞。
