Smyth Alistair G, Wu Jianhua
1 Northern and Yorkshire Cleft Lip and Palate Service, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom.
2 Dental Translational and Clinical Research Unit, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
Cleft Palate Craniofac J. 2019 Sep;56(8):1008-1012. doi: 10.1177/1055665619829388. Epub 2019 Feb 12.
To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function.
A retrospective cohort study.
A regional specialist cleft lip and palate center within United Kingdom.
PATIENTS, PARTICIPANTS: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria.
Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release.
Postoperative fistula development and velopharyngeal function at 5 years of age.
Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%).
Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.
评估腭裂修复的效果，并确定腭瘘对后续腭咽功能的影响程度。
一项回顾性队列研究。
英国一家地区性唇腭裂专科中心。
患者、参与者：2002年至2009年间出生的非综合征性婴儿，由一名外科医生进行腭裂一期手术，并在5岁时进行了结果审核。在此期间，410名婴儿接受了腭裂手术，271名婴儿符合纳入标准。
腭裂修复，包括提腭肌重新定位，可伴有或不伴有腭侧松解。
术后瘘管形成情况及5岁时的腭咽功能。
所有病例中有57%（156/271）需要进行腭侧切口。瘘管发生率为10.3%（28/271）。仅一期手术后，79%的患者（213/271）实现了足够的腭功能，且无明显腭咽闭合不全（VPI）。腭瘘与后续的VPI显著相关（风险比=3.03，95%置信区间：1.95-4.69；P<0.001）。当愈合因瘘管而复杂时，VPI的发生率从18%增加到54%。伴有瘘管的双侧唇腭裂（BCLP）修复的VPI发生率最高（71%）。
提肌复位的腭裂修复是一种有效的手术，效果良好。腭瘘对后续腭咽功能的预后影响已明确，VPI显著增加了3倍。应考虑早期修复腭瘘，特别是对于大瘘管和BCLP病例。
