Witt P D, Marsh J L, Marty-Grames L, Muntz H R, Gay W D
Department of Surgery, Plastic and Reconstructive, St. Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA.
Cleft Palate Craniofac J. 1995 May;32(3):179-87. doi: 10.1597/1545-1569_1995_032_0179_mothv_2.3.co_2.
Velopharyngeal dysfunction (VPD) resulting from an adynamic or hypodynamic velopharynx is an unusual pathology that poses vexing management problems for the Cleft Palate team. Correction of VPD has the potential for airway compromise. Endoscopically, this pathology is recognized by a large velopharyngeal (VP) gap size, which demonstrates little or no dynamic activity of the posterior or lateral pharyngeal walls nor of the velum in response to speech tasks or connected speech. Because of a paucity of literature defining the entity, a retrospective review of 175 patients who were treated for VPD at our center was undertaken. Analysis of management failures revealed an unexpected concentration of patients with hypodynamic or paretic VP mechanisms as documented by nasendoscopic assessments. A subpopulation of 41 (23%) patients with this characteristic was studied to define the patients at risk, to determine etiologic factors, and to critique intervention outcome among various surgical and nonsurgical managements. Results showed that the phenomenon of VP hypodynamism occurred more frequently in patients with submucous cleft palate (p = .014) and with VPD in association with malformation syndromes (p = .009) than in patients in other diagnostic categories. Conversely, VPD not associated with clefting occurred with greater frequency in the nonhypodynamic group than in the hypodynamic group (p = .002). Composite (surgical and prosthetic) primary management failure occurred in 42%. Between one and three procedures were necessary to achieve an acceptable speech result. We present a management algorithm and provide data regarding realistic expectations for various treatment outcomes in patients with this complex disorder, which have not, to date, been previously described.
由动力不足或动力减退的腭咽引起的腭咽功能障碍（VPD）是一种不常见的病理情况，给腭裂治疗团队带来了棘手的管理问题。VPD的矫正有可能导致气道受损。在内窥镜下，这种病理情况表现为腭咽（VP）间隙较大，在言语任务或连贯言语时，咽后壁或侧壁以及软腭几乎没有或没有动态活动。由于定义该实体的文献较少，我们对在本中心接受VPD治疗的175例患者进行了回顾性研究。对治疗失败的分析显示，经鼻内镜评估记录，动力减退或麻痹性VP机制的患者意外集中。对41例（23%）具有该特征的患者亚组进行了研究，以确定有风险的患者，确定病因因素，并评估各种手术和非手术治疗的干预结果。结果表明，与其他诊断类别的患者相比，黏膜下腭裂患者（p = 0.014）以及伴有畸形综合征的VPD患者（p = 0.009）中VP动力减退现象更频繁出现。相反，非动力减退组中不伴有腭裂的VPD发生率高于动力减退组（p = 0.002）。综合（手术和修复）初次治疗失败率为42%。需要进行一到三次手术才能获得可接受的语音结果。我们提出了一种管理算法，并提供了关于这种复杂疾病患者各种治疗结果的实际预期数据，这些数据迄今为止尚未被描述过。
