Elsherbiny Ahmed, Amerson Meghan, Sconyers Laura, Grant John H
UAB Cleft and Craniofacial Center, Children's of Alabama Hospital, Birmingham, Alabama, USA; Sohag Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, Egypt.
UAB Cleft and Craniofacial Center, Children's of Alabama Hospital, Birmingham, Alabama, USA.
J Plast Reconstr Aesthet Surg. 2018 Jun;71(6):895-899. doi: 10.1016/j.bjps.2018.01.029. Epub 2018 Feb 5.
Palatal re-repair aims to improve velar function by retro-positioning the levator veli palatini muscles. The surgery includes extensive dissection, leading to tissue edema and scar formation which may need time to remodel. Together with the change of muscle orientation and tension, it is expected that a period of time is needed to reach the final functional performance. This study attempts to determine how much time is required to reach the optimum performance of the palate after re-repair.
A retrospective chart review identified consecutive cleft patients with VPI who underwent palate re-repair procedure by a single surgeon from 2000 to 2015 and achieved normal or borderline normal VP function. Only patients who had regular postoperative follow-up visits for speech assessments until resolution of speech abnormalities were included. The percent of patients cured at each time point following surgery was recorded.
Forty-five patients met the inclusion criteria. The mean age at surgery was 6.6 ± 3.2 years. Speech abnormalities had resolved in 44.5% of patients within the first 6 months after surgery, 62.2% after up to 1 year, 75.6% after up to 2 years and 88.9% after up to 3 years post re-repair palatoplasty. The remaining 11.1% continued to improve after 3 years up to 6 years.
Re-repair procedures may take a longer time than previously thought for the final outcome to manifest. Close monitoring of improvement with continued speech therapy is recommended before deciding to move to the next surgical step in management.
腭部再次修复旨在通过将腭帆提肌向后移位来改善腭功能。该手术包括广泛的解剖，会导致组织水肿和瘢痕形成，这可能需要时间来重塑。随着肌肉方向和张力的改变，预计需要一段时间才能达到最终的功能表现。本研究试图确定腭部再次修复后需要多长时间才能达到最佳功能表现。
一项回顾性病历审查确定了2000年至2015年期间由同一位外科医生为患有腭咽闭合不全的腭裂患者进行腭部再次修复手术且获得正常或接近正常腭咽功能的连续病例。仅纳入那些术后定期进行语音评估随访直至语音异常消失的患者。记录手术后每个时间点治愈的患者百分比。
45例患者符合纳入标准。手术时的平均年龄为6.6±3.2岁。在腭部再次修复手术后的前6个月内，44.5%的患者语音异常消失，1年后为62.2%，2年后为75.6%，3年后为88.9%。其余11.1%的患者在3年后至6年期间仍持续改善。
再次修复手术可能比之前认为的需要更长时间才能显现最终结果。在决定采取下一步手术治疗措施之前，建议通过持续的语音治疗密切监测改善情况。
