Woo Albert S, Skolnick Gary B, Sachanandani Neil S, Grames Lynn M
St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine; and the Cleft Palate-Craniofacial Institute, St. Louis Children's Hospital.
Plast Reconstr Surg. 2014 Oct;134(4):588e-596e. doi: 10.1097/PRS.0000000000000506.
The Furlow palatoplasty is commonly used for the correction of velopharyngeal insufficiency in cleft patients. An alternative procedure is introduced involving a single Z-plasty with overlapping intravelar veloplasty (Woo palatoplasty). This study compared the results of both techniques in the correction of velopharyngeal insufficiency.
After institutional review board approval, a retrospective chart review was performed of all patients who had undergone secondary palatoplasty for the correction of velopharyngeal insufficiency. All nonsyndromic patients with imaging data were evaluated. Data elements included preoperative and postoperative velopharyngeal gap size and perceptual speech examination results.
Fifty-two subjects were included: 30 subjects had undergone Furlow palatoplasty and 22 underwent Woo palatoplasty. Overall, a larger proportion of Woo (95 percent) than Furlow subjects (63 percent) did not require secondary surgery (p = 0.005). However, mean presurgery closure was significantly different between groups (p = 0.042). For a more refined assessment, only those with 80 percent or greater preoperative closure were evaluated. Successful results were achieved in 67 percent (10 of 15) in Furlow and in 100 percent (19 of 19) in Woo. Again, this finding was significant (p = 0.005). Linear regression analysis suggested a significant effect of cleft type (β = 2.3, p = 0.013) on closure after repair, with decreased closure in cases with isolated cleft palate.
The Woo palatoplasty compared favorably with Furlow palatoplasty for correction of velopharyngeal insufficiency. The technique appears to be a viable alternative for palatal re-repair, especially in circumstances when Furlow palatoplasty cannot be performed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Furlow腭成形术常用于矫正腭裂患者的腭咽闭合不全。本文介绍了一种替代手术，即单Z成形术联合腭内重叠腭成形术（Woo腭成形术）。本研究比较了这两种技术在矫正腭咽闭合不全方面的效果。
经机构审查委员会批准，对所有接受二期腭成形术以矫正腭咽闭合不全的患者进行回顾性病历审查。对所有有影像学资料的非综合征患者进行评估。数据元素包括术前和术后腭咽间隙大小以及语音感知检查结果。
共纳入52名受试者：30名接受了Furlow腭成形术，22名接受了Woo腭成形术。总体而言，Woo组（95%）比Furlow组（63%）中不需要二次手术的比例更高（p = 0.005）。然而，两组术前平均闭合情况有显著差异（p = 0.042）。为了进行更精确的评估，仅对术前闭合率达80%或更高的患者进行评估。Furlow组67%（15例中的10例）取得成功结果，Woo组100%（19例中的19例）取得成功结果。同样，这一结果具有统计学意义（p = 0.005）。线性回归分析表明腭裂类型对修复后闭合有显著影响（β = 2.3，p = 0.013），孤立性腭裂患者的闭合率降低。
在矫正腭咽闭合不全方面，Woo腭成形术与Furlow腭成形术相比效果良好。该技术似乎是腭再次修复的可行替代方法，尤其是在无法进行Furlow腭成形术的情况下。
临床问题/证据级别：治疗性，III级。
