Okhiria Åsa, Persson Christina, Blom Johansson Monica, Hakelius Malin, Jabbari Fatemeh, Nowinski Daniel
Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg. Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:423-431. doi: 10.1016/j.bjps.2024.10.016. Epub 2024 Oct 11.
Several factors may influence speech outcome and the rate of secondary palatal surgery in patients with cleft palate. The aim of this study was to evaluate different types of intra-velar veloplasty within an otherwise uniform surgical protocol. The impact of cleft width and the surgeon's experience on outcome measurements was examined. This cross-sectional study included 62 individuals with unilateral cleft lip and palate born in 2000-2015. Based on the surgical technique used, they were divided into three groups. The cleft width was measured on dental casts. Blinded speech and language pathologists assessed velopharyngeal function with the composite score for velopharyngeal competence (VPC-Sum) for single words. They rated velopharyngeal function on a three-point scale (VPC-R) in sentences. Target consonants in words were phonetically transcribed. The percentage of correct consonants (PCC) was calculated. Surgical technique was not associated with any outcome. Cleft width was associated with the rate of secondary palatal surgery (OR 1.141, 95% CI 1.021-1.275, p = .020) and velopharyngeal insufficiency when using VPC-R (OR 2.700, 95% CI 1.053-6.919, p = .039) but not when using VPC-Sum (OR 1.985, 95% CI.845-4.662, p = .116). PCC was not associated with cleft width and did not differ between surgical techniques. Radical muscle dissection did not exhibit superiority over intra-velar veloplasty reinforced by the palatopharyngeal muscle. Follow-ups at later ages with larger groups will be necessary to evaluate and compare surgical techniques accurately. Cleft width had a greater impact on the rate of secondary surgery and velopharyngeal function than surgical technique, but neither affected the PCC.
腭裂患者的语音结果和二期腭裂手术率可能受到多种因素的影响。本研究的目的是在其他方面统一的手术方案内评估不同类型的腭帆内肌成形术。研究了腭裂宽度和外科医生经验对结果测量的影响。这项横断面研究纳入了62名2000年至2015年出生的单侧唇腭裂患者。根据所使用的手术技术，他们被分为三组。在石膏模型上测量腭裂宽度。盲法语音和语言病理学家用单字腭咽功能综合评分（VPC-Sum）评估腭咽功能。他们在句子中用三点量表（VPC-R）对腭咽功能进行评分。对单词中的目标辅音进行语音转录。计算正确辅音百分比（PCC）。手术技术与任何结果均无关联。腭裂宽度与二期腭裂手术率相关（OR 1.141，95%CI 1.021-1.275，p = 0.020），在使用VPC-R时与腭咽闭合不全相关（OR 2.700，95%CI 1.053-6.919，p = 0.039），但在使用VPC-Sum时不相关（OR 1.985，95%CI 0.845-4.662，p = 0.116）。PCC与腭裂宽度无关，且在不同手术技术之间无差异。根治性肌肉解剖并不比腭咽肌加强的腭帆内肌成形术更具优势。有必要在更大规模的人群中进行后期随访，以准确评估和比较手术技术。腭裂宽度对二期手术率和腭咽功能的影响大于手术技术，但两者均不影响PCC。
