Mardini Samir, Chim Harvey, Seselgyte Rimante, Chen Philip Kuo-Ting
Rochester, Minn.; Miami, Fla.; and Linkou, Taiwan From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, University of Miami Miller School of Medicine; and the Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2016 Jan;137(1):135e-141e. doi: 10.1097/PRS.0000000000001934.
The aim of this study was to evaluate, through multivariate ordinal logistic regression, variables contributing to good postoperative speech outcomes following Furlow palatoplasty.
A series of 91 consecutive patients was evaluated. Variables analyzed included demographics; speech perceptual assessment; and measures on videonasopharyngoscopy and videofluoroscopy such as preoperative closure pattern, velopharyngeal gap, and lateral pharyngeal wall motion. Univariate and multivariate analysis of predictors of high scores of articulation, nasal resonance, and resolution of velopharyngeal insufficiency were performed using simple and multinomial logistic regression. A summative perceptual assessment score was generated and analyzed for correlation with postoperative speech outcomes.
There were 39 patients (42.9 percent) with a good outcome as defined by adequate articulation and lack of velopharyngeal insufficiency with normal nasal resonance. There was improvement of articulation in 53 patients (58.2 percent), of nasal resonance in 75 patients (82.4 percent), and of velopharyngeal insufficiency in 80 patients (87.9 percent). Predictors of good postoperative speech outcomes (p < 0.05) were preoperative articulation, nasal resonance, and lateral pharyngeal wall movement greater than 37.5 percent on one side. Preoperative severity of velopharyngeal insufficiency, velopharyngeal gap, pattern of closure, age, and sex were not predictive of a good outcome. Logistic regression demonstrated that the preoperative perceptual assessment score was predictive of postoperative outcome, with a significant difference (p < 0.05) between mild and severe groups.
A scoring system based on summated perceptual assessment parameters is predictive of good postoperative speech outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
本研究旨在通过多变量有序逻辑回归评估影响Furlow腭裂修复术后良好语音效果的相关变量。
对连续91例患者进行评估。分析的变量包括人口统计学资料、语音感知评估，以及鼻咽喉镜和电视荧光透视检查的测量结果，如术前闭合模式、腭咽间隙和咽侧壁运动。采用简单和多项逻辑回归对发音、鼻共鸣高分及腭咽功能不全改善的预测因素进行单变量和多变量分析。生成并分析综合感知评估分数与术后语音效果的相关性。
根据发音良好、无腭咽功能不全且鼻共鸣正常的定义，有39例患者（42.9%）预后良好。53例患者（58.2%）的发音得到改善，75例患者（82.4%）的鼻共鸣得到改善，80例患者（87.9%）的腭咽功能不全得到改善。术后语音效果良好的预测因素（p<0.05）为术前发音、鼻共鸣，以及一侧咽侧壁运动大于37.5%。术前腭咽功能不全的严重程度、腭咽间隙、闭合模式、年龄和性别均不能预测良好的预后。逻辑回归表明，术前感知评估分数可预测术后结果，轻度和重度组之间存在显著差异（p<0.05）。
基于综合感知评估参数的评分系统可预测术后良好的语音效果。
临床问题/证据水平：风险，III级。
