Denadai Rafael, Sabbag Anelise, Vieira Pedro Ribeiro, Raposo-Amaral Cesar Augusto, Buzzo Celso Luiz, Raposo-Amaral Cassio Eduardo
Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil.
J Craniofac Surg. 2020 Jan/Feb;31(1):41-45. doi: 10.1097/SCS.0000000000005802.
The identification of variables potentially correlated with speech outcome, following posterior pharyngeal fat grafting for treatment of velopharyngeal insufficiency (VPI), can provide useful information to guide decision-making and preoperative counseling. This study assessed the predictors of speech outcome after posterior pharyngeal fat grafting for VPI management.
One hundred and sixty-seven consecutive patients with repaired cleft palate and VPI who underwent posterior pharyngeal fat grafting were retrospectively enrolled. Perceptual speech and nasendoscopic parameters were randomly rated by 3 blinded evaluators. Speech outcome was stratified based on previously published criteria. Bivariate and multivariate analyses were performed to identify independent predictors of 15-month postoperative speech outcomes.
Large velopharyngeal gap, higher number of previous palatal surgical procedures, and referral pattern (ie, patients who underwent primary palatoplasty elsewhere) were independently negative (for all, P < 0.05) predictors of speech outcome, whereas small velopharyngeal gap size was positively (P < 0.05) correlated with this outcome. Age, sex, race, Veau hierarchy, syndromic diagnosis, Angle classification of malocclusion, type of primary palatoplasty, body mass index, obstructive sleep apnea-related scores, surgical period, donor site, grafted volume, recipient site-related complications, and preoperative status (velopharyngeal closure pattern, hypernasality, audible nasal emissions, and intraoral pressure) were not associated (for all, P > 0.05) with speech outcomes.
Posterior pharyngeal fat grafting improves speech function in patients with VPI, whereas gap size, number of previous palatal surgeries, and referral pattern affect the speech outcome.
对于采用咽后壁脂肪移植治疗腭咽闭合不全（VPI）的患者，识别可能与言语结果相关的变量，可为决策制定和术前咨询提供有用信息。本研究评估了采用咽后壁脂肪移植治疗VPI后言语结果的预测因素。
回顾性纳入167例接受咽后壁脂肪移植的腭裂修复术后合并VPI的连续患者。由3名不知情的评估者对言语感知和鼻内镜参数进行随机评分。根据先前公布的标准对言语结果进行分层。进行双变量和多变量分析以确定术后15个月言语结果的独立预测因素。
腭咽间隙大、既往腭部手术次数多以及转诊模式（即在其他地方接受一期腭裂修复术的患者）是言语结果的独立负性预测因素（所有P<0.05），而腭咽间隙小与该结果呈正相关（P<0.05）。年龄、性别、种族、韦氏分级、综合征诊断、错牙合畸形的安氏分类、一期腭裂修复术类型、体重指数、阻塞性睡眠呼吸暂停相关评分、手术时间、供区、移植量、受区相关并发症以及术前状态（腭咽闭合模式、高鼻音、可闻及的鼻漏气和口腔内压力）均与言语结果无关（所有P>0.05）。
咽后壁脂肪移植可改善VPI患者的言语功能，而间隙大小、既往腭部手术次数和转诊模式会影响言语结果。
