Rossell-Perry Percy, Caceres Nano Evelyn, Gavino-Gutierrez Arquímedes M
JAMA Facial Plast Surg. 2014 May-Jun;16(3):206-10. doi: 10.1001/jamafacial.2013.2537.
IMPORTANCE This study evaluates a technique to estimate cleft severity and tissue hypoplasia in patients with cleft palate. Current classifications are limited to the morphologic characteristics of the clefts. A new classification is proposed in relation to the palatal index, which allows more individualized surgical attention for the cleft palate. OBJECTIVE To evaluate the relationship of palatal index and cleft palate repair surgical outcomes (palatal fistula and velopharyngeal insufficiency) in patients with unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Retrospective study performed by the Outreach Surgical Center Program Lima, Lima, Perú, of surgical outcomes of 152 consecutive pediatric patients, aged 12 to 15 months, with nonsyndromic unilateral complete cleft lip and palate treated during from 2001 to 2007. Findings were obtained at 1 to 5 years' follow-up. INTERVENTIONS Palatoplasty using the 2-flap technique plus intravelar veloplasty. Palate index was measured preoperatively with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES Postoperative analysis via the χ2 test to assess the statistical significance of association between the palatal index and surgical outcomes. RESULTS Palatal fistula rates correlated directly with the cleft severity, as estimated by the palatal index (P = .01), but there was no association between postoperative velopharyngeal insufficiency and palatal index (P = .76). CONCLUSIONS AND RELEVANCE The palatal index was a good predictor of fistula development in the studied group. There was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula. Further long-term study is needed to evaluate the relationship between the palatal index and maxillary growth.
重要性 本研究评估了一种用于估计腭裂患者裂隙严重程度和组织发育不全的技术。目前的分类仅限于裂隙的形态学特征。本文提出了一种与腭指数相关的新分类方法，该方法可为腭裂患者提供更具个性化的手术治疗。目的 评估单侧唇腭裂患者的腭指数与腭裂修复手术结果（腭瘘和腭咽闭合不全）之间的关系。设计、地点和参与者 秘鲁利马外展手术中心项目对2001年至2007年期间治疗的152例年龄在12至15个月的非综合征性单侧完全性唇腭裂连续儿科患者的手术结果进行了回顾性研究。随访1至5年得出研究结果。干预措施 采用双瓣技术加腭内肌成形术进行腭裂修复术。在全身麻醉下术前测量患者的腭指数。主要结局和测量指标 通过χ2检验进行术后分析，以评估腭指数与手术结果之间关联的统计学意义。结果 腭瘘发生率与腭指数所估计的裂隙严重程度直接相关（P = .01），但术后腭咽闭合不全与腭指数之间无关联（P = .76）。结论和相关性 在研究组中，腭指数是瘘管形成的良好预测指标。裂隙严重程度与组织缺损（使用该指数估计）和腭瘘的存在之间存在关联。需要进一步进行长期研究以评估腭指数与上颌骨生长之间的关系。
