Chim Harvey, Eshraghi Yashar, Iamphongsai Seree, Gosain Arun K
Cleft Palate Craniofac J. 2015 Sep;52(5):517-24. doi: 10.1597/13-187. Epub 2014 Sep 22.
The present study was performed to identify factors that lead to a favorable outcome of postpalatoplasty velopharyngeal incompetence using the double-opposing Z-palatoplasty.
A retrospective analysis was performed on 23 consecutive nonsyndromic patients who underwent secondary surgical management of velopharyngeal incompetence using a double-opposing Z-palatoplasty technique following primary, non-Furlow palatoplasty for overt cleft palate.
All subjects were evaluated preoperatively using a perceptual speech assessment scale, nasendoscopy, and videofluoroscopy. Inclusion criteria consisted of a velopharyngeal gap of 9 mm or less on phonation. Patients were followed with perceptual speech assessment for at least 1 year following secondary surgery.
The perceptual speech assessment score for all patients decreased from 6.48 ± 2.26 (mean ± standard deviation; range, 3 to 11) to 1.90 ± 1.51 (range, 0 to 6) at 6 months or more postoperatively (P < .0001). Of the 21 patients with follow-up data 1 year or more post-op, 16 (76%) achieved velopharyngeal competence and five (24%) had borderline competence. Preoperative assessment factors associated with compromised outcome included a large velopharyngeal gap of 7 to 9 mm, poor lateral wall motion of 40% or less, and an elevated perceptual speech assessment score.
Double-opposing Z-palatoplasty is a surgical technique that can be used successfully to correct velopharyngeal incompetence in selected secondary palatoplasty patients. This technique permits correction of velopharyngeal incompetence and restoration of the velopharyngeal mechanism irrespective of prior intravelar veloplasty and without accompanying loss in the nasal airway. Preoperative assessment can better identify those patients who are less likely to achieve velopharyngeal competence following double-opposing Z-palatoplasty alone.
本研究旨在确定采用双反向Z形腭裂修复术治疗腭裂术后腭咽闭合不全并取得良好效果的相关因素。
对23例连续性非综合征患者进行回顾性分析，这些患者在初次非弗洛氏腭裂修复术后因明显腭裂而采用双反向Z形腭裂修复术对腭咽闭合不全进行二次手术治疗。
所有受试者术前均采用语音感知评估量表、鼻内镜检查和电视荧光透视检查进行评估。纳入标准为发声时腭咽间隙为9毫米或更小。二次手术后对患者进行至少1年的语音感知评估随访。
所有患者术后6个月或更长时间时，语音感知评估得分从6.48±2.26（平均值±标准差；范围3至11）降至1.90±1.51（范围0至6）（P<.0001）。在术后1年或更长时间有随访数据的21例患者中，16例（76%）实现了腭咽闭合功能，5例（24%）处于临界状态。与预后不良相关的术前评估因素包括7至9毫米的大腭咽间隙、40%或更低的侧壁运动不良以及较高的语音感知评估得分。
双反向Z形腭裂修复术是一种可成功用于矫正部分二次腭裂修复术患者腭咽闭合不全的手术技术。该技术可矫正腭咽闭合不全并恢复腭咽机制，无论先前是否进行过腭内肌成形术，且不会导致鼻气道丧失。术前评估能更好地识别那些仅采用双反向Z形腭裂修复术不太可能实现腭咽闭合功能的患者。
