Park Hojin, Choi Jin Mi, Oh Tae Suk
Asan Medical Center, 65526University of Ulsan College of Medicine, Seoul, Korea.
Cleft Palate Craniofac J. 2022 Dec;59(12):1445-1451. doi: 10.1177/10556656211047139. Epub 2021 Oct 12.
Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning.
This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length.
Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001).
BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.
Furlow双反向Z成形术（DOZ）可延长软腭；然而，这种延长是以增加黏膜瓣张力为代价实现的。因此，在DOZ术后黏膜瓣张力过大的患者中，其应用受到限制。在本研究中，DOZ与颊脂垫（BFP）瓣联合使用，以最大限度地延长腭部并重新定位肌肉。
本研究纳入了2016年12月至2019年2月期间接受腭咽闭合不全手术矫正的患者。研究纳入了一期腭裂修复术后鼻音过重程度超过中度的患者。排除4岁以下患者、隐性腭裂患者或综合征患者。对仅接受DOZ手术的患者（DOZ组，n = 17）和使用BFP的患者（BFP组，n = 15）在术前和术后进行语音结果调查。在手术前后测量悬雍垂与咽壁之间的腭咽间隙，以评估腭部长度。
大多数接受BFP治疗的患者鼻音过重情况有所改善。然而，DOZ组的鼻音过重情况比BFP组更严重（p = 0.023）。DOZ组和BFP组的腭部延长程度分别为4.4±1.7毫米和7.5±2.1毫米（p = 0.001）。
BFP降低了DOZ黏膜瓣的张力，并最大限度地延长了腭部并重新定位了肌肉。它们促进了中度和中重度腭咽闭合不全患者的腭咽闭合。因此，我们的方法改善了一期腭裂修复术后腭咽闭合不全患者的手术效果。
