Askar Sherif M, El-Anwar Mohammad Waheed, Elaassar Ahmed S, Quriba Amal S, Anany Ahmed, Elmalt Ashraf, Elsayed Ahmed I, Abd El-Azeem Mohammed S
Department of Otorhinolaryngology Head & Neck Surgery, Zagazig University, Egypt.
Department of Otorhinolaryngology Head & Neck Surgery, Zagazig University, Egypt.
Int J Pediatr Otorhinolaryngol. 2018 Dec;115:65-70. doi: 10.1016/j.ijporl.2018.09.015. Epub 2018 Sep 18.
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision.
To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed.
This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall.
13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ± 1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission.
The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.
上蒂咽瓣（PF）是矫正腭咽闭合不全（VPI）最常用的外科技术。裸露的咽后壁可能会延长咽痛和不适的恢复期。供区愈合延迟问题以及转位瓣向下移位导致的纤维化可能是手术失败的原因之一，可能需要进行修复。
提出一种改良的咽瓣技术，旨在通过立即对床面头部部分进行自体黏膜覆盖来解决供区缺损问题。
对持续性VPI患者进行了该病例系列研究。所有患者均接受了新的改良头侧去黏膜化咽瓣（CDPF）技术。基本步骤是从咽后壁上部切取一个侧蒂黏膜瓣。掀起一个上蒂咽瓣（头部裸露段和尾部黏膜化段），将其从咽后壁分离并插入软腭。然后将侧蒂黏膜瓣铺展在咽后壁供区的上部。
本研究纳入了13例VPI患者。他们的年龄在5至12岁之间，平均年龄为5.6±1.2岁。随访期为8至14个月。所有的瓣和床面在2至3周内完全愈合，没有患者出现瓣裂开、感染或腭瘘。术后语音评估显示腭咽功能、共鸣平衡有显著改善，鼻漏气减少。
改良技术为咽后壁上部提供了即时的自体黏膜覆盖，因此可以促进供区一期愈合，恢复期短。CDPF将瓣和咽后壁的两个相对的创面分开。黏膜瓣可能防止瓣向下移位。
