Yamaguchi Kazuaki, Lonic Daniel, Lee Che-Hsiung, Yun Claudia, Lo Lun-Jou
Taoyuan, Taiwan.
From the Department of Plastic and Reconstructive Surgery, the Craniofacial Research Center, and the Craniofacial Center, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2016 Jun;137(6):1825-1831. doi: 10.1097/PRS.0000000000002181.
A smaller Z-plasty is applied in a modified Furlow palatoplasty. The purpose of this study was to assess its surgical and functional outcome.
The surgical technique included mucoperiosteal flap elevation in the hard palate, complete pedicle dissection and release, double-opposing Z-plasty using 5-mm limbs and muscle dissection in the soft palate, and the buccal fat pad covering lateral relaxing wounds. A retrospective chart review was conducted for 231 consecutive nonsyndromic patients undergoing modified palatoplasty from May of 2007 to December of 2014. The demographic, postoperative, and follow-up data were collected. Statistical analyses were performed.
Average age at palatoplasty was 8.3 months. The overall oronasal fistula rate was 0.4 percent; oronasal fistula occurred in only one case with bilateral cleft. Other complications included postoperative bleeding in two cases (0.8 percent), postoperative airway obstruction in one case (0.4 percent), obstructive sleep apnea in one case (0.4 percent), stitch abscess in one case (0.4 percent), and distal uvula dehiscence in two cases (0.8 percent). One hundred twenty-seven patients had full speech evaluation, and seven (5.5 percent) were diagnosed with velopharyngeal insufficiency requiring surgical correction.
This modified palatoplasty using a small double-opposing Z-plasty provided adequate cleft palate closure, with a low fistula rate and satisfactory speech outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在改良的Furlow腭裂修复术中应用较小的Z成形术。本研究的目的是评估其手术和功能效果。
手术技术包括硬腭黏骨膜瓣掀起、完全蒂部解剖与松解、使用5毫米臂的双反向Z成形术以及软腭肌肉解剖，并用颊脂垫覆盖外侧松弛伤口。对2007年5月至2014年12月连续接受改良腭裂修复术的231例非综合征患者进行回顾性病历审查。收集人口统计学、术后和随访数据，并进行统计分析。
腭裂修复术的平均年龄为8.3个月。总的口鼻瘘发生率为0.4%；口鼻瘘仅发生在1例双侧腭裂患者中。其他并发症包括2例术后出血（0.8%）、1例术后气道阻塞（0.4%）、1例阻塞性睡眠呼吸暂停（0.4%）、1例缝线脓肿（0.4%）和2例悬雍垂远端裂开（0.8%）。127例患者进行了全面的语音评估，其中7例（5.5%）被诊断为腭咽闭合不全需要手术矫正。
这种采用小双反向Z成形术的改良腭裂修复术可实现腭裂的充分闭合，口鼻瘘发生率低，语音效果良好。
临床问题/证据级别：治疗性，IV级。
