Tanaka Shoichiro A, Coombs Demetrius M, Tuncer Fatma B, Shikhman Alexander, Keenan Patricia, McNinch Neil L, Murthy Ananth S
James A. Lehman Jr. MD Craniofacial Center, Department of Pediatric Plastic and Reconstructive Surgery, Akron Children's Hospital, Akron, Ohio.
Department of Plastic Surgery, The Cleveland Clinic, Cleveland, Ohio.
Plast Reconstr Surg Glob Open. 2021 Aug 19;9(8):e3777. doi: 10.1097/GOX.0000000000003777. eCollection 2021 Aug.
The purpose of this study was to introduce a modification of the Furlow double-opposing Z-plasty (DOZ)-the square-root palatoplasty (SRP)-and critically evaluate outcomes compared to children who underwent straight-line repair (SLR).
A retrospective review was performed of all nonsyndromic children undergoing primary cleft palate closure either by SRP or SLR at our institution between 2009 and 2017. Outcomes of interest included rates/location of oronasal fistula, secondary surgery, speech delay/deficits, resonance, nasal air emission (NAE), articulation errors, and velopharyngeal function. Logistic regression was used to assess for the effect of surgery type on outcomes while controlling for Veau cleft type, age, and gender.
Seventy-eight patients were included; 46 (59%) underwent SRP, and 32 (41%) underwent SLR. The mean follow-up was 4.07 years. When compared to SLR, children who underwent SRP were less likely to have oronasal fistula [odds ratio (OR) 4.8, = 0.0159], speech delay/deficits (OR 7.7, < 0.001), NAE (OR 9.7, < 0.001), articulation errors (OR 10.2, < 0.001), or need for secondary speech surgery (OR 13.2, < 0.0002). Patients who underwent SRP were also more likely to have normal resonance (78.26% versus 43.75%, respectively; = 0.0043) and good VP function (84.78% versus 56.25%, respectively; = 0.0094).
This study describes and evaluates outcomes following a modified-Furlow DOZ technique-the SRP. After adjusting for Veau classification, age, and gender in nonsyndromic children, SRP is associated with significantly less speech delay/deficits, NAE, articulation errors, and need for secondary speech surgery when compared to children who underwent SLR.
本研究的目的是介绍一种改良的弗洛（Furlow）双反向Z成形术（DOZ）——平方根腭裂修复术（SRP），并与接受直线修复术（SLR）的儿童进行比较，严格评估其治疗效果。
对2009年至2017年期间在本机构接受SRP或SLR进行一期腭裂修复的所有非综合征性儿童进行回顾性研究。感兴趣的结果包括口鼻瘘的发生率/位置、二次手术、言语延迟/缺陷、共鸣、鼻漏气（NAE）、发音错误和腭咽功能。在控制了韦氏（Veau）腭裂类型、年龄和性别后，采用逻辑回归分析评估手术类型对结果的影响。
共纳入78例患者；46例（59%）接受了SRP，32例（41%）接受了SLR。平均随访时间为4.07年。与SLR相比，接受SRP的儿童发生口鼻瘘的可能性较小[比值比（OR）为4.8，P = 0.0159]，言语延迟/缺陷（OR为7.7，P < 0.001）、NAE（OR为9.7，P < 0.001）、发音错误（OR为10.2，P < 0.001）或二次言语手术需求（OR为13.2，P < 0.0002）。接受SRP的患者也更有可能具有正常共鸣（分别为78.26%和43.75%；P = 0.0043）和良好的腭咽功能（分别为84.78%和56.25%；P = 0.0094）。
本研究描述并评估了改良弗洛DOZ技术——SRP术后的效果。在对非综合征性儿童的韦氏分类、年龄和性别进行校正后，与接受SLR的儿童相比，SRP与明显更少的言语延迟/缺陷、NAE、发音错误以及二次言语手术需求相关。
