Jackson I T, McLennan G, Scheker L R
Plast Reconstr Surg. 1983 Aug;72(2):153-7. doi: 10.1097/00006534-198308000-00005.
Staged palatal closure was carried out in 30 children. The soft palate was closed at 9 months and the hard palate at 5 years. These patients were followed up for 7 years, and it was found that although the incidence of lateral crossbite was reduced in both unilateral and bilateral cases, the speech results were less satisfactory than those obtained with total palatal closure. In this series, there were two fistulae at the junction of the hard and soft palate. This was related to difficulty in closing this area in some patients at the time of the second operation. As a result, the procedure is not advised. An alternative palatal closure technique is described. This technique consists of nasal layer closure, careful dissection and reconstruction of the levator musculature, transverse division of the nasal layer, insertion of a buccal flap for lengthening, and closure of the oral layer with Veau flaps without dissection behind the tuberosities and with almost total closure of the lateral donor sites on the palatal shelves. In this way there is minimal scarring, particularly in the retrotuberosity area. This is felt to be important since it would seem from studies of facial growth that this is a much more significant area than the palatal shelves.
对30名儿童实施了分期腭裂修复术。软腭在9个月时进行修复，硬腭在5岁时修复。对这些患者进行了7年的随访，发现尽管单侧和双侧病例的侧方反合发生率均有所降低，但语音效果不如一期腭裂修复术。在这个系列中，硬腭与软腭交界处出现了2个瘘管。这与部分患者在第二次手术时该区域的关闭困难有关。因此，不建议采用这种手术方法。文中描述了一种替代性的腭裂修复技术。该技术包括鼻腔层关闭、仔细解剖和重建提肌组织、鼻腔层横向分离、插入颊瓣进行延长，以及用韦氏瓣关闭口腔层，在结节后方不进行解剖，腭板上的侧方供区几乎完全关闭。通过这种方式，瘢痕形成最少，尤其是在结节后区域。这一点被认为很重要，因为从面部生长研究来看，这个区域似乎比腭板更重要。
