Dentino Kelley M, Marrinan Eileen M, Brustowicz Katherine, Mulliken John B, Padwa Bonnie L
Clinical Research Fellow, Harvard Medical School, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Research Instructor, Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY.
J Oral Maxillofac Surg. 2016 Jun;74(6):1207-14. doi: 10.1016/j.joms.2015.12.016. Epub 2016 Jan 7.
Patients with repaired cleft lip and cleft palate (CL/P) can develop velopharyngeal insufficiency (VPI) after Le Fort I maxillary advancement. The aim of this study was to evaluate speech outcomes in patients who required a pharyngeal flap after Le Fort I maxillary advancement.
This retrospective cohort study included all patients with repaired CL/P who underwent a Le Fort I osteotomy and subsequently required a pharyngeal flap to correct VPI. Patients were included if they had outcome measurements documented at 3 time points: 1) before Le Fort I (baseline), 2) after Le Fort I, and 3) after pharyngeal flap. Outcome measurements, including speech characteristics (resonance, nasal emission, and intraoral pressure) and velopharyngeal function, were evaluated on perceptual assessment by a speech pathologist specializing in cleft care. Velopharyngeal closure was assessed with multi-view videofluoroscopy or nasopharyngoscopy. Patient characteristics and descriptive statistics were summarized and continuous data were expressed as mean ± standard deviation. Repeated-measures analysis of variance and paired samples t test were used to measure changes in speech outcome variables between time points. All P values were 2-tailed and considered significant for values less than .05.
There were 23 patients for analysis (13 girls [56.5%] and 10 boys [43.5%]). Two patients (9%) had cleft palate only, 9 (39%) had unilateral cleft lip and palate (CLP), and 12 (52%) had bilateral CLP. Follow-up evaluations performed on average 12 months postoperatively showed statistically meaningful improvement for all variables, including decreased hypernasality, reduced nasal emission, and increased intraoral pressure for consonant production. Patients with repaired CL/P who had VPI after Le Fort I maxillary advancement showed significant improvement in all outcome measurements after pharyngeal flap (P < .001).
The superiorly based pharyngeal flap is highly successful in correcting VPI after Le Fort I maxillary advancement in patients with repaired CL/P.
唇腭裂（CL/P）修复患者在Le Fort I型上颌骨前移术后可能出现腭咽闭合不全（VPI）。本研究的目的是评估Le Fort I型上颌骨前移术后需要咽瓣的患者的语音结局。
这项回顾性队列研究纳入了所有接受过Le Fort I型截骨术且随后需要咽瓣来纠正VPI的CL/P修复患者。如果患者在3个时间点有记录的结局测量数据，则纳入研究：1）Le Fort I型手术前（基线），2）Le Fort I型手术后，3）咽瓣手术后。结局测量包括语音特征（共鸣、鼻漏气和口腔内压力）和腭咽功能，由一位专门从事腭裂护理的言语病理学家通过感知评估进行评价。通过多视角电视荧光透视检查或鼻咽喉镜检查评估腭咽闭合情况。总结患者特征和描述性统计数据，连续数据以均值±标准差表示。采用重复测量方差分析和配对样本t检验来测量时间点之间语音结局变量的变化。所有P值均为双侧检验，P值小于0.05被认为具有统计学意义。
共有23例患者纳入分析（13例女性[56.5%]，10例男性[43.5%]）。2例患者（9%）仅患有腭裂，9例（39%）患有单侧唇腭裂（CLP），12例（52%）患有双侧CLP。术后平均12个月进行的随访评估显示，所有变量均有统计学意义的改善，包括鼻音过重减轻、鼻漏气减少以及辅音发音时口腔内压力增加。Le Fort I型上颌骨前移术后出现VPI的CL/P修复患者在咽瓣手术后所有结局测量指标均有显著改善（P < 0.001）。
对于CL/P修复患者，带蒂咽瓣在纠正Le Fort I型上颌骨前移术后的VPI方面非常成功。
