From the Departments of Plastic Surgery and Otolaryngology and the School of Medicine, University of Pittsburgh; Ohio State University; and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.
Plast Reconstr Surg. 2021 May 1;147(5):1141-1148. doi: 10.1097/PRS.0000000000007897.
The submucous cleft palate can be overt or occult and may require surgical repair. The double-opposing Z-plasty (Furlow repair) is the authors' center's preferred approach. This study evaluated complication rates, differences in outcome between overt and occult types, and patient factors associated with surgical failure.
This retrospective study reviewed documentation on all patients who underwent Furlow Z-plasty for submucous cleft palate at a single center between 2004 and 2018. Speech pathology was quantified using the Pittsburgh Weighted Speech Score.
A total of 351 patients were included (125 overt and 226 occult cases). Furlow Z-plasty was successful (postoperative Pittsburgh Weighted Speech Score <7 without recommendation for secondary speech surgery) in 291 patients (82.1 percent). Apart from those requiring secondary surgery, there were no documented complications. Occult-type patients were 7.5 years old at palatoplasty with a speech score of 14.1; overt-type patients were 6.5 years old with a score of 15.7. Postoperative speech scores were similar for both groups. Secondary speech surgery patients had a higher preoperative score (16.9 versus 14.2). Age at time of palatoplasty and submucous cleft palate type were not predictive of the need for secondary surgery. Syndromic patients had higher preoperative and postoperative speech scores (15.6 and 7.5, respectively) than nonsyndromic patients (14.3 and 4.3) and needed secondary surgery more often (24.4 percent versus 9.2 percent). V-shaped velar vaulting on preoperative assessment was present in 92 percent of occult-type patients.
Furlow palatoplasty is a safe and effective means of repairing submucous cleft palate. Patients with the occult type presented later with a lower Pittsburgh Weighted Speech Score. High preoperative speech score and syndromic status were associated with the need for secondary speech surgery. V-shaped velar vaulting is a reliable sign of occult submucous cleft palate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
黏膜下腭裂可为显性或隐性，可能需要手术修复。双反对 Z 成形术（Furlow 修复术）是作者所在中心的首选方法。本研究评估了并发症发生率、显性和隐性类型之间的结果差异，以及与手术失败相关的患者因素。
本回顾性研究对 2004 年至 2018 年期间在单一中心接受 Furlow Z 成形术治疗黏膜下腭裂的所有患者的病历进行了回顾。语音病理学使用匹兹堡加权语音评分进行量化。
共纳入 351 例患者（显性 125 例，隐性 226 例）。291 例患者（82.1%）Furlow Z 成形术成功（术后匹兹堡加权语音评分<7 且无需推荐二次语音手术）。除需要二次手术的患者外，无记录并发症。隐性型患者腭裂手术时年龄为 7.5 岁，语音评分为 14.1；显性型患者为 6.5 岁，评分为 15.7。两组术后语音评分相似。二次语音手术患者术前评分较高（16.9 比 14.2）。腭裂手术时的年龄和黏膜下腭裂类型均不能预测是否需要二次手术。综合征患者术前和术后的语音评分均较高（分别为 15.6 和 7.5），而非综合征患者分别为 14.3 和 4.3，且更常需要二次手术（24.4%比 9.2%）。术前评估发现 92%的隐性型患者存在 V 形软腭穹窿。
Furlow 腭裂修复术是修复黏膜下腭裂的一种安全有效的方法。隐性型患者就诊较晚，匹兹堡加权语音评分较低。术前语音评分高和综合征状态与需要二次语音手术相关。V 形软腭穹窿是隐性黏膜下腭裂的可靠征象。
临床问题/证据水平：风险，II 级。
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