Ettinger Russell E, Kung Theodore A, Wombacher Natalie, Berger Mary, Newman M Haskell, Buchman Steven R, Kasten Steven J
1 University of Michigan Section of Plastic Surgery, Ann Arbor, MI, USA.
2 Craniofacial Anomalies Program, University of Michigan, Ann Arbor, MI, USA.
Cleft Palate Craniofac J. 2018 Mar;55(3):430-436. doi: 10.1177/1055665617726989. Epub 2017 Dec 14.
Submucous cleft palate (SMCP) is the most common form of cleft involving the posterior palate, resulting in variable degrees of velar dysfunction and speech disturbance. Although early surgical intervention is indicated for patients with true cleft palate, the indications for palatoplasty and timing of surgical intervention for patients with SMCP remain controversial.
Twenty-nine patients with SMCP were retrospectively reviewed. Patients treated with Furlow palatoplasty were dichotomized based on patient age at the time of surgical correction into early speech development and late speech development. Primary outcome measures included standardized assessments of hypernasal resonance and quantitative pre- and postoperative nasometry scores. Patients managed nonoperatively were included for comparison of early and late speech outcomes.
Both early and late groups demonstrated improvement in qualitative assessment of hypernasal resonance following Furlow palatoplasty. Early and late groups also had significant improvement in pre- to postoperative nasometry scores from 7.4 to 2.3 SD from norm ( P = .01) and 6.0 to 3.6 SD from norm ( P = .02), respectively. There was no difference in postoperative nasometry scores between early and late groups, 2.3 and 3.6 SD ( P = .12).
Furlow palatoplasty significantly improves the degree of hypernasality in patients with SMCP based on pre- and postoperative nasometry scores and on qualitative assessment of hypernasality. There were no differences in speech outcomes based on early compared with late operative intervention. Therefore, early palatal repair is not obligatory for optimal speech outcomes in children with SMCP and palatoplasty should be deferred until the emergence of overt velopharyngeal insufficiency.
黏膜下腭裂（SMCP）是累及腭后部最常见的腭裂形式，会导致不同程度的腭功能障碍和言语障碍。虽然真正腭裂患者需要早期手术干预，但SMCP患者的腭裂修复术适应证和手术干预时机仍存在争议。
对29例SMCP患者进行回顾性分析。接受Furlow腭裂修复术的患者根据手术矫正时的年龄分为早期言语发育组和晚期言语发育组。主要结局指标包括对高鼻音的标准化评估以及术前和术后鼻测量计分数。纳入非手术治疗的患者以比较早期和晚期的言语结局。
早期和晚期组在Furlow腭裂修复术后高鼻音的定性评估方面均有改善。早期和晚期组术前至术后鼻测量计分数也分别有显著改善，从高于正常均值7.4标准差降至2.3标准差（P = 0.01）和从高于正常均值6.0标准差降至3.6标准差（P = 0.02）。早期和晚期组术后鼻测量计分数无差异，分别为2.3和3.6标准差（P = 0.12）。
根据术前和术后鼻测量计分数以及高鼻音的定性评估，Furlow腭裂修复术可显著改善SMCP患者的高鼻音程度。早期与晚期手术干预的言语结局无差异。因此，对于SMCP患儿，早期腭裂修复并非获得最佳言语结局的必要条件，腭裂修复术应推迟至明显的腭咽闭合不全出现时进行。
