Johns D F, Cannito M P, Rohrich R J, Tebbetts J B
Division of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas.
Plast Reconstr Surg. 1994 Sep;94(3):436-45. doi: 10.1097/00006534-199409000-00003.
We present a rationale and step-by-step description of a previously unpublished innovative surgical technique designed to overcome velopharyngeal insufficiency. This procedure maintains the anatomic integrity and physiologic function of the velopharynx by limiting interpalatal dissection and incorporates a method for flap attachment through the velum that is accessible, predictable, and versatile. The efficacy of this procedure in eliminating velopharyngeal insufficiency was evaluated by using rigorously controlled quantitative psychophysical scaling procedures of presurgical and postsurgical perceptual ratings of resonance, nasal emission, and intelligibility and instrumental acoustic analyses. The results indicated significantly better postsurgical speech outcomes by individuals treated with the pull-through velopharyngoplasty than did patients treated with other procedures designed for the secondary management of velopharyngeal insufficiency. Based on our experience with more than 150 patients, we believe that the self-lined superiorly based pull-through velopharyngoplasty represents an advancement in the surgical treatment of velopharyngeal insufficiency.
我们提出了一种用于克服腭咽闭合不全的创新手术技术的基本原理和详细步骤描述，该技术此前尚未发表。此手术通过限制腭间分离来维持腭咽部的解剖完整性和生理功能，并纳入了一种通过软腭进行皮瓣附着的方法，该方法易于操作、可预测且用途广泛。通过使用严格控制的定量心理物理学缩放程序，对手术前后的共鸣、鼻漏气和可懂度进行感知评分，并进行仪器声学分析，以此评估该手术消除腭咽闭合不全的效果。结果表明，与采用其他用于腭咽闭合不全二次治疗的手术方法的患者相比，接受经咽腭成形术治疗的个体术后语音效果明显更好。基于我们对150多名患者的经验，我们认为自衬里上蒂经咽腭成形术代表了腭咽闭合不全外科治疗的一项进展。
