Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Auris Nasus Larynx. 2020 Apr;47(2):245-249. doi: 10.1016/j.anl.2019.08.003. Epub 2019 Aug 28.
Conventional pharyngeal flap surgery, which closes the median portion of the velopharynx, has been performed for dysarthria patients with velopharyngeal insufficiency (VPI). However, for VPI due to unilateral pharyngeal paralysis, median closing disrupts pharyngeal contraction of the unaffected side and allows pharyngeal pressure to escape through the nose at the lateral portion of the affected side during speech and swallowing. The purpose of this study was to evaluate the effectiveness of lateral pharyngeal flap (LPF) surgery for unilateral VPI.
Seven patients with unilateral VPI (five males and two females with an average age of 54 years) underwent LPF surgery combined with other transoral surgeries for dysphagia. The LPF surgical technique was as follows: after the laterocaudal-based pedicle flap of the soft palate and cranial-based pedicle flap of the posterior pharyngeal wall on the affected side were transorally elevated, each mucosal pedicle flap was sutured together. Functional oral intake scale (FOIS) scores and swallowing pressure before and after surgery were compared.
Unilateral velopharyngeal closure preserved nasal breathing after LPF surgery in all patients. Rhinolalia aperta improved postoperatively in all patients except one. The mean FOIS scores were 2.3 preoperatively and 3.7, 5.3, and 5.9 at 2 weeks, 1 month, and 6 months postoperatively, respectively. The mean pressures significantly increased at the velopharynx (from 49±30mmHg to 92±45mmHg) and oropharynx (from 48±18mmHg to 66±15mmHg) six months after the surgery.
LPF surgery leaving the unaffected side intact can be an effective surgical procedure for patients with unilateral VPI.
传统的咽瓣手术会关闭咽腔的中部，从而治疗腭咽闭合不全（VPI）的构音障碍患者。然而，对于单侧咽麻痹导致的 VPI，咽中份的关闭会破坏未受累侧的咽收缩，并在言语和吞咽时允许咽压从受累侧的侧方漏出。本研究旨在评估单侧 VPI 的外侧咽瓣（LPF）手术的有效性。
7 例单侧 VPI 患者（5 例男性，2 例女性，平均年龄 54 岁）接受了 LPF 手术联合其他经口手术以治疗吞咽困难。LPF 手术技术如下：经口提起软腭的后外侧基底部蒂瓣和后咽壁的颅基底蒂瓣后，将每个黏膜蒂瓣缝合在一起。比较手术前后的功能性口腔摄入量表（FOIS）评分和吞咽压。
所有患者的 LPF 手术后单侧咽腔关闭均能保持鼻呼吸通畅。除 1 例患者外，所有患者的开放性鼻音均得到改善。术前平均 FOIS 评分为 2.3，术后 2 周、1 个月和 6 个月分别为 3.7、5.3 和 5.9。术后 6 个月，咽腔（从 49±30mmHg 增加到 92±45mmHg）和口咽（从 48±18mmHg 增加到 66±15mmHg）的平均压力显著增加。
保留未受累侧完整的 LPF 手术对于单侧 VPI 患者是一种有效的手术方法。
