Logjes Robrecht J H, Upton Susanna, Mendelsohn Bryce A, Badiee Ryan K, Breugem Corstiaan C, Hoffman William Y, Pomerantz Jason H
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, Calif.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University Medical Center Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands.
Plast Reconstr Surg Glob Open. 2021 Jan 21;9(1):e3351. doi: 10.1097/GOX.0000000000003351. eCollection 2021 Jan.
Whether treatment of cleft palate (CP) associated with Robin sequence (RS) should attain outcomes similar to those of isolated cleft palate (ICP) remains unknown. This study compares treatment and outcomes in both conditions and delineates predictors of long-term outcome.
This retrospective case series of consecutive syndromic and isolated RS- and ICP-patients (1990-2016) includes indications and outcomes of straight-line repair with intravelar veloplasty (SLIV) or Furlow repair depending on cleft and airway characteristics.
Seventy-five RS and 83 ICP patients underwent CP repair. Velopharyngeal insufficiency (VPI) occurred in 41% of RS versus 17% of ICP patients ( = 0.012), and in 60% of patients with syndromic RS versus 16% with isolated RS ( = 0.005). In multivariable logistic regression analysis, wider and more severe CP anatomy was the only factor independently associated with VPI ( = 0.028), in contrast to age at repair, syndromic RS compared with isolated RS, and isolated RS compared with ICP and initial tongue-lip adhesion. Secondary Furlow after primary SLIV was used to treat VPI in all groups, and more frequently in syndromic versus isolated RS patients ( = 0.025).
Variability of RS anatomy and airway compromise necessitates individualized treatment protocols. Despite differing CP etiology and other variables, our findings demonstrate cleft anatomy as the only independent variable predictive of VPI comparing RS and ICP patients. Patients with isolated RS should ultimately attain similar VPI outcomes compared with ICP patients. Obstructive speech operations in RS patients can be avoided without compromising speech outcome by reserving the prsocedure for secondary cases.
与罗宾序列征（RS）相关的腭裂（CP）治疗效果是否应与孤立性腭裂（ICP）相似仍不清楚。本研究比较了这两种情况下的治疗方法和结果，并确定了长期预后的预测因素。
这项对连续的综合征性和孤立性RS及ICP患者（1990 - 2016年）的回顾性病例系列研究包括根据腭裂和气道特征采用直线修复联合腭帆内缩术（SLIV）或弗洛修复术的适应证和结果。
75例RS患者和83例ICP患者接受了腭裂修复术。腭咽闭合不全（VPI）在41%的RS患者中出现，而在ICP患者中为17%（P = 0.012），在综合征性RS患者中为60%，而在孤立性RS患者中为16%（P = 0.005）。在多变量逻辑回归分析中，更宽且更严重的腭裂解剖结构是与VPI独立相关的唯一因素（P = 0.028），与修复年龄、综合征性RS与孤立性RS相比、孤立性RS与ICP及初始舌唇粘连情况相反。在所有组中，初次SLIV后采用二次弗洛修复术治疗VPI，在综合征性RS患者中比孤立性RS患者更频繁（P = 0.025）。
RS解剖结构的变异性和气道损害需要个体化的治疗方案。尽管腭裂病因和其他变量不同，但我们的研究结果表明，在比较RS和ICP患者时，腭裂解剖结构是预测VPI的唯一独立变量。孤立性RS患者最终应能获得与ICP患者相似的VPI结局。通过将手术保留用于二次病例，RS患者的阻塞性语音手术可以避免，而不会影响语音结局。
