Baek Rong-Min, Kim Baek-Kyu, Jeong Jae Hoon, Ahn Taeseon, Park Mikyong, Han Jihyeon
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2017 May;70(5):646-652. doi: 10.1016/j.bjps.2016.12.025. Epub 2017 Mar 7.
Submucous cleft palate is a congenital deformity that may present as velopharyngeal insufficiency. The degree of anatomical abnormality varies widely among patients and does not predict severity of symptom. We present our 10-year experience treating submucous cleft palate patients with double opposing z-plasty and explore the effect of age at surgery and compensatory articulation on speech.
Preoperative assessment included intraoral examination, nasoendoscopy, and perceptual speech evaluation. Age, gap size, and severity of hypernasality were assessed to determine the timing and type of surgery. A retrospective study of 74 submucous cleft palate patients undergoing double-opposing z-plasty from 2005 to 2016 by a single surgeon (Baek RM) was conducted. Double opposing z-plasty was modified to fully release all abnormal insertions of the levator veli palatini muscle. Postoperative velopharyngeal function was measured and statistical analyses were performed.
The ages of patients at surgery ranged from 11 months to 19 years. Postoperatively 87 percent of the patients achieved velopharyngeal competency and 13 percent had remaining mild hypernasality. Age was a significant factor in predicting speech outcome, and patients receiving surgery prior to the age of 5.5 years had a higher normalization rate. Compensatory articulation did not have an impact on postoperative hypernasality. There were no cases of postoperative hyponasality or airway problems.
Satisfactory speech outcome was achieved with the authors' protocol and modification of the double-opposing z-plasty. A comprehensive assessment of patient age, intraoral findings, severity of hypernasality, and gap size, is necessary for proper treatment of submucous cleft palate patients.
黏膜下腭裂是一种先天性畸形，可能表现为腭咽闭合不全。患者之间解剖学异常的程度差异很大，且无法预测症状的严重程度。我们介绍了我们在采用双反向Z形瓣修复术治疗黏膜下腭裂患者方面的10年经验，并探讨了手术年龄和代偿性发音对语音的影响。
术前评估包括口腔检查、鼻内镜检查和感知语音评估。评估年龄、裂隙大小和鼻音过重的严重程度，以确定手术时机和类型。对2005年至2016年由单一外科医生（白RM）进行双反向Z形瓣修复术的74例黏膜下腭裂患者进行了回顾性研究。对双反向Z形瓣修复术进行了改良，以完全松解腭帆提肌的所有异常附着。测量术后腭咽功能并进行统计分析。
患者的手术年龄为11个月至19岁。术后87%的患者实现了腭咽闭合功能，13%仍有轻度鼻音过重。年龄是预测语音结果的一个重要因素，5.5岁之前接受手术的患者正常化率更高。代偿性发音对术后鼻音过重没有影响。没有术后鼻通气不足或气道问题的病例。
作者的方案和改良的双反向Z形瓣修复术取得了令人满意的语音效果。对黏膜下腭裂患者进行适当治疗，需要对患者年龄、口腔检查结果、鼻音过重的严重程度和裂隙大小进行全面评估。
