From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil.
Ann Plast Surg. 2024 Apr 1;92(4):395-400. doi: 10.1097/SAP.0000000000003809.
Palatal lengthening is becoming a first-line treatment choice for cleft patients with velopharyngeal insufficiency (VPI). As cleft palate-related surgical outcomes are age dependent, speech outcomes may be similarly affected by patient age at the time of treatment. The primary goal of this study is to determine whether there are age-related speech outcome differences when double opposing buccinator myomucosal flaps are used as part of a palatal lengthening protocol and whether these outcome differences preclude utilization of this technique for specific patient age groups.
A retrospective study was performed on consecutive nonsyndromic patients with VPI who underwent treatment using double opposing buccinator myomucosal flaps at our hospital between 2014 and 2021. Patients who completed the 15-month follow-up were stratified by age. Group A aged between 2 and 7 years (n = 14), group B aged 8 and 18 years (n = 23), and group C aged older than 18 years (n = 25) were included. Standardized perceptual speech evaluations and nasopharyngoscopy were performed. Hypernasality, soft palate mobility, and lateral palatal wall mobility were assessed both preoperatively and at a 15-month postoperative interval. Complications were also recorded. The χ2 test was used for statistical comparison.
All of the age-stratified patient groups in this study showed significant improvement in hypernasality, soft palate mobility, and lateral wall mobility (P < 0.01), with no statistically significant differences between the different patient age groups. Overall speech success was achieved in 69.4% of patients. Patients in group A achieved 78.6% speech success, patients in group B achieved 78.3% speech success, and patients in group C achieved 56% speech success, with no statistically significant differences being shown regarding speech success between the different patient age groups (P > 0.05).
Regardless of age, palatal lengthening via double opposing buccinator myomucosal flaps similarly improves speech outcomes.
腭延长术已成为伴有腭咽闭合不全（VPI）的腭裂患者的一线治疗选择。由于腭裂相关手术结果与年龄有关，因此治疗时患者的年龄可能同样会影响语音结果。本研究的主要目的是确定在使用双对向颊肌黏膜瓣作为腭延长方案的一部分时，是否存在与年龄相关的语音结果差异，以及这些结果差异是否排除了该技术在特定年龄段患者中的应用。
对 2014 年至 2021 年在我院接受双对向颊肌黏膜瓣治疗的 VPI 非综合征患者进行回顾性研究。完成 15 个月随访的患者按年龄分层。A 组年龄在 2 至 7 岁（n = 14），B 组年龄在 8 至 18 岁（n = 23），C 组年龄大于 18 岁（n = 25）。进行了标准化的感知语音评估和鼻咽镜检查。评估术前和 15 个月术后的鼻音、软腭活动度和侧腭壁活动度。还记录了并发症。使用 χ2 检验进行统计学比较。
本研究中所有年龄分层的患者组在鼻音、软腭活动度和侧壁活动度方面均有显著改善（P < 0.01），不同患者年龄组之间无统计学差异。总体上有 69.4%的患者获得了成功的语音效果。A 组患者的语音成功率为 78.6%，B 组为 78.3%，C 组为 56%，不同患者年龄组之间的语音成功率无统计学差异（P > 0.05）。
无论年龄大小，通过双对向颊肌黏膜瓣进行腭延长均可相似地改善语音结果。
