大龄腭裂患者术后腭咽闭合功能的影响因素分析

目的 探究大龄腭裂患者一期腭裂整复术后腭咽闭合功能的影响因素。方法 本研究回顾了2009—2014年间在四川大学华西口腔医院唇腭裂外科以Furlow术式行手术治疗的大龄腭裂患者（手术年龄≥5岁）,收集其软腭长度、咽腔深度、腭裂宽度、上颌宽度、腭裂指数和腭咽比6项指标的术中测量数据以及术后至少1年的语音复诊结果,进行logistic回归分析。结果 共纳入患者131人,其中男性70人,女性61人。logistic回归分析发现患者咽腔深度同术后腭咽功能强相关,咽腔深度越大,术后腭咽闭合不全风险升高。咽腔深度大于16 mm的患者术后腭咽闭合功能显著性降低,其他测量指标同术后腭咽功能无明显关联性。结论 大龄腭裂患者咽腔深度是其术后腭咽功能的敏感预测指标。对于咽腔深度大于16 mm的患者,可考虑一期手术时同步实施腭咽联合手术,以创造更好的腭咽闭合条件。     

大龄腭裂患者术后腭咽闭合功能的影响因素分析

目的 探究大龄腭裂患者一期腭裂整复术后腭咽闭合功能的影响因素。方法 本研究回顾了2009—2014年间在四川大学华西口腔医院唇腭裂外科以Furlow术式行手术治疗的大龄腭裂患者（手术年龄≥5岁）,收集其软腭长度、咽腔深度、腭裂宽度、上颌宽度、腭裂指数和腭咽比6项指标的术中测量数据以及术后至少1年的语音复诊结果,进行logistic回归分析。结果 共纳入患者131人,其中男性70人,女性61人。logistic回归分析发现患者咽腔深度同术后腭咽功能强相关,咽腔深度越大,术后腭咽闭合不全风险升高。咽腔深度大于16 mm的患者术后腭咽闭合功能显著性降低,其他测量指标同术后腭咽功能无明显关联性。结论 大龄腭裂患者咽腔深度是其术后腭咽功能的敏感预测指标。对于咽腔深度大于16 mm的患者,可考虑一期手术时同步实施腭咽联合手术,以创造更好的腭咽闭合条件。     

评价腭裂患者术后软腭功能的研究

腭裂术后患者腭咽闭合功能的恢复,是检查手术疗效的关键。而软腭的运动,又是腭咽闭合活动中的重要部分。本研究采用腭咽闭合图像处理定量检测系统和鼻咽腔钡剂造影X线摄片的方法,检测了90例不同手术年龄及手术方法腭裂患者的软腭功能。结果如下:采用传统性腭成形术的小年龄手术组(小于3岁)都能获得较为理想的软腭活动功能,而大年龄手术组(大于6岁)无论采用传统性腭成形术或Furlow＇s反向双Z瓣修复术,均无理想的软腭活动,证实了腭裂的手术年龄越小,软腭活动效果越理想的结论。作者并提出腭成形术宜早期进行。     

腭裂术后腭咽闭合不全患者成年期腭咽结构特征的分析

目的分析腭裂术后腭咽闭合不全(VPI)患者成年期腭咽结构形态特征与腭咽功能之间的关系.方法应用回顾性研究的方法对23例初期腭成形术后腭咽闭合不全患者(年龄16～36岁,平均年龄18.3岁,男10例,女13例,男女=11.3)与20例健康对照组(年龄在16～24岁,平均年龄18.6岁,男女=0.821)分别拍摄静止时的X线头颅侧位定位片,比较2组间软腭长度、咽腔深度、咽腔高度、adequate ratio=软腭长度/咽腔深度的差异;分析咽三角(由翼颅基点,第一颈椎,后鼻棘构成)以及软腭与咽后壁相接触点(PPW)在咽三角的位置关系.结果VPI组患者软腭长度、adequate ratio小于健康对照组,PPW点在咽三角的位置相对于正常组偏上(P＜0.05);翼颅基点和第一颈椎位置在2组间并无差异(P＞0.05).结论腭裂术后VPI患者在成期表现出软腭长度过短,ratio值＜1.0,整个咽三角相对于正常组微呈逆时针偏转,PPW点位置上移的形态特征.提示腭裂修复应选择重建软腭功能长度、保留正常腭咽结构的个体化治疗方法.     

Sommerlad腭帆提肌重建术修复腭裂后腭咽结构特征的分析

目的 分析Sommerlad腭帆提肌重建术后腭咽闭合完全患者生长发育期腭咽结构特征与腭咽功能之间的关系。方法 对18例Sommerlad腭帆提肌重建术修复不完全性腭裂术后腭咽闭合完全患者（T1组）、14例Langenbeck法修复不完全性腭裂术后腭咽闭合不全患者（T2组）及正常人13例（对照组）进行鼻咽纤维镜检测和X线头颅侧位片分析,比较3组间腭咽闭合度、软腭长度、咽腔深度、Adequate ratio（软腭长度/咽腔深度）的差异,分析软腭与咽后壁接触点PPW在腭咽三角的位置关系。结果 T1组18例患者腭咽闭合完全;T2组有7例患者腭咽闭合度达到70%,5例为50%~70%,2例在50%以下。T1组软腭长度、Adequate ratio与对照组无明显差异（P>0.05）,腭咽结构图与对照组相似。T2组软腭长度和Adequate ratio分别为（22.9±2.3） mm、0.95±0.14,均小于T1组[（25.7±2.3） mm、1.43±0.26]及对照组[（29.9±2.7） mm、1.45±0.26],其差异有统计学意义（P<0.05）;PPW点在腭咽三角的位置相对于对照组偏上。结论 Sommerlad腭帆提肌重建术后腭咽闭合完全患者的腭咽结构与正常人相似;Langenbeck法修复术后腭咽闭合不全患者表现为咽腔过深,Adequate ratio值小于1.0,整个腭咽三角呈逆时针偏转上移的特征。     

上颌前徙术对上颌发育不足患者腭咽部结构影响的临床探讨

目的：探讨上颌前移术对上颌发育不足患者腭咽部结构的影响。方法：选择2011-2013年行上颌Le FortI型截骨前移术的上颌发育不足患者12例,男7例,女5例,其中唇腭裂患者5例,非唇腭裂患者7例,平均年龄22．21岁,所有患者在术前、术后1月拍摄头颅定位侧位片,并对腭咽部结构指标进行测量分析。结果：上颌骨最大前移幅度8mill,最小3mm,平均前移（5．28±2．32）mm,术后咽腔深度明显增大（P〈0．05）;同时软腭长度及软硬腭夹角较术前11月显增大（P〈0．05）,软腭厚度减小。结论：上颌骨前移术造成患者咽腔深度显著增加,对腭咽闭合功能可能有不利影响：术后腭叫部软组织发生适应性变化,这种代偿性改变会在一定程度上减轻腭咽闭合不全。     

不同咽成形术式对腭裂术后继发腭咽闭合功能不全合并睡眠呼吸障碍的影响

目前国际上治疗腭裂继发腭咽闭合不全的常用术式包括咽后壁瓣成形术、腭咽肌瓣成形术和Furlow瓣(双反向Z形瓣).多导睡眠监测(polysomnography,PSG)结合主诉症状表明,部分腭裂术后腭咽闭合不全患者在接受咽成形术后会出现不同程度的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apne...     

大年龄腭裂患者术后腭咽闭合功能的影响因素

目的 研究2岁以上腭裂患者术后腭咽闭合功能的影响因素。方法 对245例2岁以上腭裂患儿术后腭咽闭合功能和可能影响术后腭咽闭合功能的因素（腭咽比值、腭裂类型、手术年龄、术式）进行回顾性研究。结果 腭咽闭合不全（ VPI）组和腭咽闭合完全（ VPC）组术前相对裂隙宽度、腭咽比值差异无统计学意义。不同年龄组、不同腭裂类型术后腭咽闭合率未见明显差异。不同的术式术后腭咽闭合率差异有统计学意义。结论 大年龄腭裂患者的治疗不宜照搬 2岁以下患儿单纯行腭裂整复术的常规治疗方案。裂隙的大小不是影响大年龄腭裂患者术后腭咽闭合功能的主要因素。 Sommerlad腭帆提肌重建术 +腭咽肌瓣咽成形术可明显改善大年龄患者术后腭咽闭合功能,在一期手术时应采用这种腭咽联合手术。     

腭裂整复术中肌肉功能性重建的研究进展

腭裂是口腔颌面部常见的先天性疾病之一，影响患者的饮食、语音和听力等重要的生理功能。行软腭内成形术重建腭咽肌肉，可以提高术后腭咽闭合率，改善患者术后的听力和语言能力。目前，腭裂整复时重建腭咽肌肉功能性已被大多数外科医生所认同，主要分歧在于术中肌肉解剖的程度、重建方式和肌肉功能性重建对腭咽功能、语音和听力的影响。本文就软腭内成形术与肌肉解剖、软腭内成形术与软腭功能、软腭内成形术与听力和软腭内成形术与术后腭瘘等研究进展作一综述。     

咽后壁瓣咽成形术对腭裂术后患者颌面部生长影响的初步研究

目的 通过对颌面部软、硬组织形态的测量分析,探讨咽后壁瓣咽成形术对腭裂术后患者颌面部生长的影响。方法 对56例腭裂术后腭咽闭合不全患者,采用病例对照研究：A组21例,为腭裂术后行咽后壁瓣咽成形术患者;B组（对照组1） 15例,为腭裂术后行Furlow腭再成形术患者;C组（对照组2） 20例,为腭裂术后未行二期手术患者。对所有患者随访1年以上的X线头影侧位片进行测量,硬组织测量包含颅底、上颌骨、面高3个方面,软组织包含10个面部轮廓指标,用SPSS 21.0软件进行统计学分析。结果 手术年龄4～7岁的咽瓣手术患者与同年龄行腭再成形术及腭裂术后未行二期手术患者相比较,在水平及垂直方向上,软、硬组织生长均未见明显差异。结论 咽后壁瓣咽成形术对腭裂术后患者的颌面部生长发育没有明显影响。     

An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure

The aim of this study was to compare velopharyngeal closure between patients who underwent Furlow palatoplasty and two-flap palatoplasty. A retrospective review of 88 patients with incomplete palate cleft was performed. 48 patients (17 males; 31 females) aged 2-28 years received Furlow palatoplasty. 40 patients (17 males; 23 females) aged 2-21 years received two-flap palatoplasty. Velopharyngeal function was categorized as adequate, marginal or inadequate. Complications associated with the operation were documented. Statistically significant differences were not found amongst sex distribution, age at operation, follow-up time, and preoperative speech intelligibility. After primary repairs using Furlow and two-flap palatoplasty, the surgeon's incidence of postoperative palatal fistula was 0%. The complications were not significantly different between the two groups. The authors achieved the lowest reported incidence of postoperative palatal fistulas in primary Furlow palatoplasty. The outcomes of the velopharyngeal closure were better in patients who received Furlow palatoplasty (P<0.05). Furlow palatoplasty was more effective than two-flap palatoplasty in obtaining perfect velopharyngeal closure. A probable explanation may be that Furlow palatoplasty can reposition and overlap the divergent palatal muscle and lengthen the soft palate.     

联合应用Sommerlad与Furlow术式治疗腭咽闭合不全

目的基于Sommerlad腭帆提肌重建和Furlow反向双"Z"两种术式的优缺点,探讨联合两种术式的改良设计治疗腭咽闭合不全的可行性和有效性。方法对腭裂修复术后确诊腭咽闭合不全的患者,采用Sommerlas术式重建腭帆提肌,恢复肌肉功能的同时,采用Furlow术式延长软腭,重建腭咽闭合生理功能的解剖学结构。术后3个月经鼻咽纤维镜检查评估腭咽闭合功能。结果改良的联合术式设计可明显提高腭咽闭合不全患者的腭咽闭合率。结论将2种不同术式联合应用,有很强的可行性和可操作性,组织精细解剖复位和准确可靠的缝合技术是确保该术式成功实施的关键。可用于腭裂术后继发腭咽闭合不全的治疗。     

Sommerlad–Furlow modified palatoplasty: A retrospective study

The purpose of this study was to introduce the surgical process of Sommerlad–Furlow modified (S–F) palatoplasty and compare its surgical and functional outcomes with conventional Sommerlad (S) palatoplasty.Patients with non-syndromic cleft palate who had undergone either S–F palatoplasty or S palatoplasty were retrospectively reviewed. Data on the outcomes of velopharyngeal function and postsurgical palatal fistula incidence were collected for all patients. Data for preselected factors, including gender, age at palatoplasty, and cleft type, were also collected. Chi-square tests were conducted.1254 patients were included. The postsurgical velopharyngeal competence (VPC) rate after S–F palatoplasty was significantly higher than after S palatoplasty (total, 70.5% vs 57.9%, p < 0.0001; age ≤ 1, 87.0% vs 69.2%, p < 0.0001; 1 < age ≤ 2, 78.3% vs 69.3%, p = 0.0479). With regard to different types of cleft palate, the postsurgical VPC rates after S–F palatoplasty were all significantly higher than for S palatoplasty in all patients younger than 2 years of age (complete cleft palate, 78.7% vs 62.4%, p = 0.0016; hard and soft palate cleft, 84.4% vs 74.8%, p = 0.0172; submucosal cleft and soft palate cleft, 96.6% vs 68.4%, p = 0.0114). The postoperative fistula rate after S–F palatoplasty was 4.3%.This modified palatoplasty technique provided adequate cleft palate closure, with satisfactory speech outcomes and low fistula rates, while older age at palatoplasty may affect the postsurgical outcomes. Within the limitations of the study it seems that the Sommerlad–Furlow modified technique is an option for cleft palate repair.     

Furlow palatoplasty to restore velopharyngeal competence following tonsillectomy avulsion of a pharyngeal flap.

OBJECTIVE: We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal flap that had been previously established to treat velopharyngeal insufficiency associated with a submucous cleft palate. INTERVENTION: A tonsillectomy, conducted by a surgeon unaffiliated with a cleft palate team, was used to remove enlarged tonsils that had developed after pharyngeal flap surgery and extended into the lateral ports causing nasal obstruction and hypernasality because of mechanical interference with port closure. A posttonsillectomy evaluation revealed avulsion of the pharyngeal flap, which was successfully treated using a Furlow palatoplasty. CONCLUSIONS: To our knowledge, this is the first report of iatrogenic avulsion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy should not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled otolaryngologist, preferably one affiliated with a multidisciplinary cleft palate team who is familiar with pharyngoplasty surgery. Finally, our experience would suggest that the Furlow palatoplasty is sufficiently robust to be used as a secondary salvage procedure to restore velopharyngeal sufficiency following iatrogenic avulsion of a pharyngeal flap.     

Evaluation of velopharyngeal function after later surgical repair of cleft palate. ]

This study detected 60 cases of patients of later surgical cleft palate repairing with different operative procedures,based on nasopharyngeal fiberscope and image processing detective system of nasopharyngeal function.They were divided into two groups,30 cases with Furlow's double reversing Z plasty,and others with traditional palatoplasty.The results were as follows:the type of velopharyngeal closure with later palatoplasty mainly were circus,semi-circus,and the rate of operative success only was 46.6%,which was lower than other reports.Author described that compensation of lateral and posterior pharyngeal wall made the type of velopharyngeal closure.The elder the age,the more the compensation is.For the late cleft palate repair,although the variable surgical procedure made a condition for speech improvement, patients with later cleft palate repair still can't improve their phonation.     

Preoperative velopharyngeal closure ratio correlates with Furlow palatoplasty outcome among patients with nonsyndromic submucous cleft palate

This study aimed to explore the preoperative factors that are potentially associated with the outcome of Furlow palatoplasty in treating nonsyndromic submucous cleft palate (SMCP). In this study, we reviewed patients with nonsyndromic SMCP who received Furlow palatoplasty between 2008 and 2017 at our department. A comprehensive panel of preoperative variables was included for analyses including gender, age at operation, concurrence of cleft lip, preoperative hypernasality, nasal emission, velopharyngeal closure ratio (VCR), velopharyngeal closure pattern, velum and pharyngeal wall movement, presence of Passavant Ridge and articulation error. The improvement of velopharyngeal function was considered a good outcome. Both univariate and multivariate analyses were performed to screen the potential predictors of the postoperative velopharyngeal function. Multivariate regression analyses indicated preoperative VCR as the only factor that was significantly associated with surgical outcome (p = 0.025). The receiver operating characteristic curve and Youden index indicated that VCR>52.5% was the cutoff value for predicting preferable postoperative velopharyngeal function (OR, 0.240; 95% IC, 0.059–0.979; p = 0.047). In conclusion, Furlow palatoplasty was recommended for non-syndromic SMCP patient with preoperative VCR>52.5% as the primary surgical treatment.     

Longitudinal follow-up of obstructive sleep apnea following Furlow palatoplasty in children with cleft palate: a preliminary report.

OBJECTIVE: To longitudinally investigate the incidence and severity of obstructive sleep apnea (OSA) following Furlow palatoplasty for velopharyngeal insufficiency (VPI) in children with cleft palate. SUBJECTS: Ten children, six boys and four girls, mean age 5.1 years, at Furlow palatoplasty. DESIGN: Prospective analysis. MAIN OUTCOME MEASURES: Overnight polysomnographic studies were used to determine the incidence and severity of sleep apneas 1 day prior to Furlow palatoplasty, 1 week postoperatively, and approximately 3 and 6 months postoperatively. RESULTS: None of the patients suffered OSA prior to Furlow palatoplasty. A high incidence of mild OSA (100%) occurred during the early postoperative period (p <.001) but resolved within 3 months in all but two patients (20%). Only one OSA (10%) persisted 6 months postoperatively. CONCLUSIONS: Furlow palatoplasty for VPI in children with cleft palate might induce temporary and mild OSA.     

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate

BackgroundThe aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair.Patients and methodsPatients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria.ResultsA total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively).ConclusionThe similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.     

皮罗序列征患儿腭裂的改良手术治疗：12例临床分析

目的 探讨治疗皮罗序列征患儿腭裂安全、有效的功能性外科方案。方法 选择12例重度皮罗序列征腭裂患儿,腭裂修复术前,为纠正重度缺氧,均实行下颌骨牵张成骨。采用软腭不后退腭帆提肌重建的改良手术进行腭裂修复。结果 12例患皮罗序列征的腭裂患儿,经软腭不后退提肌重建的改良手术后,随访10~12个月,均获得了腭咽闭合功能恢复又不造成呼吸困难的临床效果。结论 对皮罗序列征的腭裂患儿进行腭裂修复手术,有别于一般的腭裂修复手术,应防止腭瓣后徙引起的呼吸窘迫。     

Die Gaumenplastik nach Furlow – Erfahrungen an 114 konsekutiven Fällen

After introducing the Furlow’s double opposing palatoplasty [4] in our clinic in 1991 114 patients were operated on and registered prospectively. Using this procedure for closure of small clefts and/or with moderate velopharyngeal incompetence only at the beginning it became the method of choice not only for primary palatoplasty at the age of 18–24 months but also for corrective measures now. An increase of length of the soft palate of 10±3 mm at the average was gained immediately after surgery. There were no specific side effects of the method, especially no fistulas occurred. Good speech results were obtained in 61% at the age of 8 years using profound phoniatric tests. Mixed velopharyngeal closure investigated by means of nasal videoscopy was the dominating form in 55%. The results underwent a positive change comparing results in patients after longitudinal investigation at the age of 5 and 8 years bzw. They corresponded with or exceeded the results found in a control group operated on with other methods of palatoplasty at another centre.