Abdel-Aziz Mosaad, Talaat Ahmed, El-Tahan Abdel-Rahman, Kamel Ahmed, Ghandour Hassan, Abdel-Hameed Asmaa
Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Otolaryngology, Suez Canal University Hospital, Ismailia, Egypt.
Int J Pediatr Otorhinolaryngol. 2020 Jun;133:109977. doi: 10.1016/j.ijporl.2020.109977. Epub 2020 Mar 4.
Posterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI.
Thirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed.
Significant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively.
A modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.
腭裂修复术后腭部后份缺损并非罕见问题，可能导致腭咽闭合不全（VPI）。本研究旨在评估一种蒂在上的咽瓣（PF）经末端改良以适应缺损在治疗腭裂修复术后VPI中的有效性。
本研究纳入了13例因腭裂修复术后腭部后份缺损导致VPI的患儿。所有患者均采用PF治疗，瓣的下端修成V形以适应缺损形状，并剥离其覆盖黏膜以促进伤口愈合。将PF深深插入腭部口腔层与鼻腔层之间缺损处形成的隧道内。采用听觉感知评估（APA）、鼻音测量评估和腭咽镜检查进行术前和术后评估。
无论是口语还是鼻音语句，APA和鼻音评分均有显著改善。此外，腭咽镜检查显示所有患者术后腭咽完全闭合。
改良PF是治疗腭裂修复术后可能出现的腭部后份缺损所致VPI的有效方法。
