Speech Therapy Unit, Alfredo Gantz Mann Foundation.
Otorhinolaryngology Unit, Surgery Service, Dr Luis Calvo Mackenna Hospital, Facultad de Ciencias de la Rehabilitación, Carrera de Fonoaudiología, Universidad Andres Bello.
J Craniofac Surg. 2021;32(2):698-704. doi: 10.1097/SCS.0000000000007514.
Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery. The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higher presentation in Soft Cleft Palate and Hard and Soft Cleft Palate. Twenty-seven patients (19%) had surgical indication for VPI correction, and 20 of them received VPI surgery, before school age. Cleft type and gender were significantly associated with VPI surgery indication rate. Postsurgery, 80% presented normal resonance. Nasal emission improved in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.
语音对唇腭裂患者的生活质量有非常重要的影响。恢复组织解剖结构和功能是初次腭裂手术的主要目标。成功处理腭裂的多种因素相关，包括需要进行腭咽闭合不全（VPI）二次手术。本研究旨在确定在我们机构接受手术的腭裂患儿的语音和腭咽功能结果，并确定是否需要进行 VPI 二次手术。对 2009 年 1 月至 2012 年 12 月出生的非综合征性腭裂患者的临床记录进行回顾性分析，这些患者在我们机构接受了多学科治疗。142 名患者接受了初次腭裂手术。80 名（56%）为男性，62 名（44%）为女性。22 名患者为软腭裂，9 名患者为软硬腭裂，84 名患者为单侧腭裂，27 名患者为双侧唇腭裂。12%的患者出现了腭裂瘘，在软腭裂和软硬腭裂中，腭裂瘘的发生率明显更高。27 名（19%）患者有 VPI 矫正手术指征，其中 20 名患者在学龄期前接受了 VPI 手术。腭裂类型和性别与 VPI 手术指征率显著相关。手术后，80%的患者共振正常。85%的患者鼻发射改善。85%的患者鼻音计值从 45%降低至 31%。低鼻音增加了 10%。1 例患者出现完全皮瓣裂开。术前规划必须仔细、个体化，以获得成功。建议进行未来的前瞻性研究，考虑所有变量进行正确分析，以提高我们的结果。
