Davies Alex, Davies Amy, Wren Yvonne, Deacon Scott, Cobb Alistair R M, Chummun Shaheel
South West Cleft Service, 1980University of Bristol Dental Hospital, Bristol, United Kingdom.
The Cleft Collective, 1980University of Bristol, Bristol, United Kingdom.
Cleft Palate Craniofac J. 2022 May;59(5):659-668. doi: 10.1177/10556656211019616. Epub 2021 Jun 4.
The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure.
We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study.
The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units.
We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( < .001), increasing palatal soft-edge width ( < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions.
The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.
在英国，腭部修复的主要方法是腭内肌成形术（IVVP）。在中线处对齐口腔黏膜以实现无张力修复并非总是可行的。增加侧方松解切口可能有助于口腔黏膜的移位以实现关闭。本研究的目的是探索可能易导致需要松解切口以实现腭部关闭的腭裂特征。
我们利用英国腭裂协作队列研究的数据进行了一项全国性多机构回顾性研究。
研究样本包括在英国所有16个腭裂治疗单位进行腭部关闭时接受IVVP的474例患者。
我们发现有强有力的证据表明，根据韦氏分类法，腭裂程度增加的患者（P <.001）、腭部软边缘宽度增加的患者（P <.001）需要松解切口，并且有中等证据表明皮埃尔·罗宾序列患者使用松解切口的相关性（P =.015）。没有足够的数据来探讨结节间距离和使用松解切口与瘘管形成之间的关系。
本研究结果确定了增加需要侧方松解切口以实现腭部关闭可能性的腭裂特征。在IVVP中增加松解切口对上颌生长和语音结果的影响程度尚不清楚。需要进一步研究来回答这个重要问题。
