Yamaguchi Kazuaki, Lonic Daniel, Lee Che-Hsiung, Wang Shu-Hui, Yun Claudia, Lo Lun-Jou
Taoyuan, Taiwan.
From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2016 Aug;138(2):290e-299e. doi: 10.1097/PRS.0000000000002386.
A simple algorithm is applied to treat velopharyngeal insufficiency. The purpose of this study was to assess its success rate and complications.
The diagnosis includes speech perceptual assessment and nasopharyngoscopy, focusing on velopharyngeal closure ratio. The treatment is composed of a double-opposing Z-plasty for marginal velopharyngeal insufficiency or a pharyngeal flap for moderate to severe velopharyngeal insufficiency. A retrospective chart review was conducted for 84 consecutive nonsyndromic postpalatoplasty patients undergoing velopharyngeal insufficiency surgery from August of 2007 to December of 2014. The demographic, perioperative, and follow-up data were collected. Statistical analyses were performed.
Mean age at velopharyngeal insufficiency surgery was 7.0 years. The overall improvement rate for patients was 86.9 percent. Nine patients in the double-opposing Z-plasty group and two patients in the pharyngeal flap group were refractory to velopharyngeal insufficiency surgery. The improvement rates for each surgical group were 80.4 percent for the double-opposing Z-plasty group and 94.7 percent for the pharyngeal flap group. There were no significant differences in postoperative velopharyngeal function between the coronal and noncoronal groups. Airway-associated complications were observed in nine patients (10.7 percent). The complications in the double-opposing Z-plasty group were observed in two patients (4.3 percent), and none of the patients presented obstructive sleep apnea. Seven patients (18.4 percent) in the pharyngeal flap group showed postoperative snoring, and one (2.6 percent) of them presented with obstructive sleep apnea.
The authors' algorithm is a simple patient- and surgeon-friendly strategy to obtain satisfactory improvement of velopharyngeal function for velopharyngeal insufficiency patients, with a low risk of airway complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
应用一种简单算法治疗腭咽闭合不全。本研究旨在评估其成功率及并发症。
诊断包括言语感知评估和鼻咽镜检查，重点关注腭咽闭合率。治疗方法为，对于边缘性腭咽闭合不全采用双反向Z成形术，对于中重度腭咽闭合不全采用咽瓣术。对2007年8月至2014年12月期间连续84例接受腭咽闭合不全手术的非综合征性腭裂修复术后患者进行回顾性病历审查。收集人口统计学、围手术期及随访数据，并进行统计分析。
腭咽闭合不全手术时的平均年龄为7.0岁。患者的总体改善率为86.9%。双反向Z成形术组有9例患者、咽瓣术组有2例患者对腭咽闭合不全手术效果不佳。双反向Z成形术组的改善率为80.4%，咽瓣术组为94.7%。冠状面组和非冠状面组术后腭咽功能无显著差异。9例患者（10.7%）出现气道相关并发症。双反向Z成形术组2例患者（4.3%）出现并发症，且均未出现阻塞性睡眠呼吸暂停。咽瓣术组7例患者（18.4%）术后打鼾，其中1例（2.6%）出现阻塞性睡眠呼吸暂停。
作者提出的算法是一种简单且对患者和外科医生均友好的策略，可为腭咽闭合不全患者带来满意的腭咽功能改善，气道并发症风险较低。
临床问题/证据级别：治疗性，IV级
