Damalachervu Mukunda Reddy, Yellinedi Rajesh, Nuvvula Rambabu, A Dharanipriya
Basavatarakam Smile Train Centre, Department of Plastic & Reconstructive Surgery, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India.
Indian J Plast Surg. 2023 Apr 13;56(2):112-117. doi: 10.1055/s-0043-1762905. eCollection 2023 Apr.
Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by various techniques of intravelar veloplasty (IVVP) leads to higher incidence of VPI due to scar contracture. Furlow's Z plasty has long, narrow, thin mucosal flaps and mucomuscular flaps with malaligned muscle closure. We present a technique of "hybrid palatoplasty" which borrows from and adds to the existing methods, is robust, is easy to replicate, and results in normal speech consistently. (1) To design a technique of "hybrid palatoplasty"-combining double opposing Z (DOZ) plasty and IVVP, which is applicable to all types of cleft palate. (2) To evaluate the results of cleft palate children operated using the technique of "hybrid palatoplasty" from 2014 to 2015 in terms of surgical complications (fistulae and dehiscence) and incidence of VPI. Our procedure combines aspects of both DOZ and IVVP. It is simplified with design of smaller Z plasties. On one side, from the oral Z plasty muscle is dissected off and sutured to the nasal mucomuscular flap of the opposite side to complete the palatal sling. Oral Z plasty is purely mucosal and reverse of the nasal side. A total of 123 cases, operated below 5 years of age were followed up. Speech was assessed by direct evaluation and tele-evaluation. A total of 123 cases, below 5 years of age, were operated between 2014 and 2016 with at least 5 years of follow-up. Note that 120 had normal speech, and 3 had VPI of which 2 were subsequently corrected and went on to develop normal speech. This novel "hybrid palatoplasty" is a simple technique with good speech outcome as it combines the principles of Z plasty and direct muscle repair with palatal sling formation.
旨在实现零腭咽闭合不全（VPI）的软腭修复手术技术尚未达成。通过各种腭内腭成形术（IVVP）技术对软腭进行直线缝合，由于瘢痕挛缩，导致VPI的发生率更高。Furlow Z成形术具有长、窄、薄的黏膜瓣和肌肉排列不齐的黏膜肌瓣。我们提出一种“混合腭成形术”技术，该技术借鉴并补充了现有方法，操作简便、易于复制，且能持续产生正常语音效果。（1）设计一种“混合腭成形术”技术——结合双反向Z（DOZ）成形术和IVVP，适用于所有类型的腭裂。（2）评估2014年至2015年采用“混合腭成形术”技术进行手术的腭裂患儿在手术并发症（瘘管和裂开）及VPI发生率方面的结果。 我们的手术结合了DOZ和IVVP的特点。通过设计较小的Z成形术使其得到简化。在一侧，从口腔Z成形术中分离肌肉并缝合至对侧的鼻腔黏膜肌瓣以完成腭吊带。口腔Z成形术纯粹是黏膜层面的，与鼻腔侧相反。对123例5岁以下接受手术的患儿进行了随访。通过直接评估和远程评估对语音进行了评价。 2014年至2016年期间，对123例5岁以下患儿进行了手术，并进行了至少5年的随访。其中120例语音正常，3例存在VPI，其中2例随后得到纠正并逐渐发展为语音正常。 这种新颖的“混合腭成形术”是一种简单的技术，具有良好的语音效果，因为它结合了Z成形术和直接肌肉修复以及腭吊带形成的原则。
