Ogata Hisao, Sakamoto Yoshiaki, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2017 Mar 13;5(3):e1256. doi: 10.1097/GOX.0000000000001256. eCollection 2017 Mar.
The goals of successful palate repair include optimization of speech and feeding, avoidance of fistula formation, and mitigation of adverse maxillary growth. However, the effects of scar formation on maxillary growth have not been discussed in detail.
Between November 2010 and December 2011, the palateplasty was performed for 24 patients with cleft palate (median age, 12 months; range, 11-18 months). In the velum, a symmetrical intravelar veloplasty with mucosal Z-plasty was performed on both the nasal and oral sides. In the hard palate, instead of lateral relaxing incisions, a 1-line mucoperiosteal incision along the cleft margins was designed with subperiosteal undermining in the entire palatine bone. The palatal mucoperiosteum was sutured together in the middle of the cleft, and the cleft was directly closed without lateral relaxing incisions. The patients were monitored for 6 months to 1.6 years.
None of the cases had issues concerning flap viability, and all palate repairs healed well. Postoperative results were satisfactory, without any complications such as dehiscence, perforation, or palatal fistula.
The method presented in this article was effective, with successful palatal closure and without scar formation or mucosal defects along the alveolus. We conclude that minimum contracture of the hard palate was useful for not only mitigating adverse maxillary growth but also for orthodontics.
成功的腭裂修复目标包括优化语音和喂养、避免瘘管形成以及减轻上颌骨生长异常。然而，瘢痕形成对上颌骨生长的影响尚未得到详细讨论。
2010年11月至2011年12月期间，对24例腭裂患者（中位年龄12个月；范围11 - 18个月）进行了腭裂修复术。在软腭，于鼻腔侧和口腔侧均进行了带黏膜Z成形术的对称腭帆内成形术。在硬腭，未采用侧方松弛切口，而是沿裂隙边缘设计了一条黏膜骨膜切口，并在整个腭骨进行骨膜下剥离。腭部黏膜骨膜在裂隙中间缝合在一起，直接关闭裂隙，未做侧方松弛切口。对患者进行了6个月至1.6年的随访。
所有病例均未出现皮瓣存活问题，所有腭裂修复均愈合良好。术后结果令人满意，未出现诸如裂开、穿孔或腭瘘等并发症。
本文介绍的方法有效，腭裂关闭成功，且沿牙槽嵴无瘢痕形成或黏膜缺损。我们得出结论，硬腭最小程度的挛缩不仅有助于减轻上颌骨生长异常，而且有助于正畸治疗。
