Çelik Muzaffer
Cranioplast, Plastic, and Craniofacial Surgery Clinic, Istanbul, Turkey.
J Craniofac Surg. 2017 Oct;28(7):e616-e617. doi: 10.1097/SCS.0000000000003609.
Cleft palate is one of the challenging problems in the field of craniofacial surgery. In particular, the conventional methods of bilateral and severe cleft palate repairs have failed to achieve normal speech. In most instances, secondary procedures such as pharyngoplasty and pharyngeal flap surgery are performed to improve speech.This study introduces secondary palatal elongation (SPE) as a new approach to cleft palate repair. The patients included usually had a short palate and unrepaired palatal muscles. The authors' procedure involved dissecting the previously repaired palatal mucosa and pushing back and cutting the nasal mucosa of the palate horizontally and further pushing it back. Then, 1 or 2 buccal mucosal flaps were used to repair the nasal mucosal defect of the palate. In case of unrepaired veloplasty from the primary surgery, the levator muscles were dissected and sutured together to perform veloplasty. The range of palatal elongation was 15 to 25 mm.Secondary palatal elongation has been performed on 17 patients since 2007 with a high rate of speech improvement. Based on this 9-year experience with performing SPE, SPE is a radical anatomic technique of palatal elongation as compared with pharyngoplasty and pharyngeal flap surgery. All 17 patients who underwent SPE showed improvement in speech, from very poor to poor speech and from normal to good speech.
腭裂是颅面外科领域具有挑战性的问题之一。特别是，传统的双侧严重腭裂修复方法未能实现正常语音。在大多数情况下，需要进行诸如咽成形术和咽瓣手术等二次手术来改善语音。本研究引入了二次腭延长术（SPE）作为一种新的腭裂修复方法。纳入的患者通常腭部较短且腭部肌肉未修复。作者的手术步骤包括解剖先前修复的腭黏膜，水平向后推开并切开腭部鼻黏膜，然后进一步向后推。然后，使用1或2个颊黏膜瓣修复腭部鼻黏膜缺损。如果初次手术时未进行腭帆成形术，则解剖提肌并缝合在一起进行腭帆成形术。腭部延长的范围为15至25毫米。自2007年以来，已对17例患者进行了二次腭延长术，语音改善率较高。基于这9年进行SPE的经验，与咽成形术和咽瓣手术相比，SPE是一种彻底的腭部延长解剖技术。所有接受SPE的17例患者的语音均有改善，从极差到差，从正常到良好。
