From the Division of Plastic Surgery, Stanford University School of Medicine; and the Northern California Kaiser Permanente Regional Craniofacial Clinic, Department of Plastic Surgery, Kaiser Permanente Santa Clara.
Plast Reconstr Surg. 2019 Jun;143(6):1246e-1254e. doi: 10.1097/PRS.0000000000005645.
The pharyngeal flap is one of the oldest and most popular techniques for correction of velopharyngeal insufficiency. The authors describe a large series using a technique that combines a pharyngeal flap with a palate pushback to avoid common causes of operative failure while restoring the velopharyngeal mechanism.
A retrospective cohort study was performed of patients who underwent a pushback pharyngeal flap by a single surgeon from 2000 to 2017. All patients had a preoperative nasoendoscopy diagnostic of velopharyngeal insufficiency. Operative technique involved elevation of the hard palate mucosa through a retroalveolar incision, passage of the flap through the nasopharyngeal mucosa opening, and inset with sutures through the hard palate mucosa.
There were 40 patients with a median age of 9.7 years. Preoperative closure patterns were predominately coronal (85.7 percent), with poor posterior wall motion and an average gap size of 27.5 mm. Postoperative complications included flap dehiscence (n = 1), transient dysphagia (n = 2), obstructive sleep apnea (n = 4), and a palatal fistula and/or persistent velopharyngeal insufficiency that required further surgery (n = 6). At an average of 2.5 years postoperatively, 91.7 percent of patients achieved adequate velopharyngeal function, with significant improvements in the majority of speech metrics (p < 0.001).
The pushback pharyngeal flap is a safe and effective technique for treatment of velopharyngeal insufficiency. Advantages include high, secure inset with prevention of palatal scar contracture and shortening.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
咽瓣是矫正腭咽闭合不全的最古老、最常用的技术之一。作者描述了一种使用咽瓣与腭后推相结合的技术的大型系列研究，该技术避免了常见的手术失败原因，同时恢复了腭咽机制。
对 2000 年至 2017 年间由一位外科医生进行的咽后推瓣术的患者进行了回顾性队列研究。所有患者术前均行鼻内镜诊断为腭咽闭合不全。手术技术涉及通过牙槽后切口提起硬腭黏膜，将瓣穿过鼻咽黏膜开口，并通过硬腭黏膜缝合固定。
共有 40 例患者，中位年龄为 9.7 岁。术前闭合模式主要为冠状位（85.7％），后咽壁运动不良，平均间隙大小为 27.5mm。术后并发症包括瓣裂开（n=1）、短暂性吞咽困难（n=2）、阻塞性睡眠呼吸暂停（n=4）以及腭瘘和/或持续腭咽闭合不全需要进一步手术（n=6）。术后平均 2.5 年，91.7％的患者获得了足够的腭咽功能，大多数语音指标均有显著改善（p<0.001）。
咽后推瓣术是治疗腭咽闭合不全的一种安全有效的技术。其优点包括高位、安全的固定，可预防腭部瘢痕挛缩和缩短。
临床问题/证据水平：治疗，IV。
