Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
St. Louis Children's Hospital, St. Louis, Missouri, USA.
Cleft Palate Craniofac J. 2024 Jan;61(1):61-67. doi: 10.1177/10556656221116534. Epub 2022 Aug 1.
A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency.
A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction.
Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, < .001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, = .757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤ ≤ .975).
A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction.
腭裂修复术后发生腭瘘是一种不良后果。即使修复了瘘管，腭瘘是否会影响咽腔闭合尚不清楚。本研究旨在确定软腭裂瘘对发生腭咽闭合不全风险的影响。
对 2000 年至 2015 年间行初次腭裂修复术且在 4 岁时具有完整记录的患者进行回顾性图表分析。将初次腭裂修复术后发生的涉及硬腭的瘘管分为软腭或硬腭瘘管。建立强制进入多变量逻辑回归模型，以检测咽腔功能障碍的预测因子。
分析了 329 例患者的记录，平均随访 8.7 年。329 例患者中有 89/329 例（27%）出现腭瘘，29/329 例（9%）患者进行了独立的瘘管修复。在有瘘管的患者中，44%的患者仅硬腭有瘘管，56%的患者软腭有瘘管。与无瘘管的患者相比，软腭瘘患者发生咽腔功能障碍的比率显著更高（OR 3.875，CI：1.964-7.648， < 0.001），而硬腭瘘患者则无显著差异（OR 1.140，CI：0.497-2.613， = 0.757）。Vau 分类、初次修复年龄和综合征状态均不是 VPI 的显著预测因子（0.128≤ ≤ 0.975）。
软腭裂瘘是初次腭裂修复术后发生咽腔功能障碍的显著预测因子。在瘘管修复时进行手术干预，增加血管化组织可能有助于预防咽腔功能障碍的发生。
