5岁以下腭裂患儿术后腭咽闭合功能变化规律的研究

目的 探讨低龄腭裂患儿术后腭咽闭合功能恢复规律,及与年龄、腭裂类型和不同复诊时间等因素的相关关系。方法 本研究纳入有2次以上复诊记录的5岁以下腭裂患者,回顾其术后腭咽闭合功能的连续性评估结果,分别进行单因素和多因素logistic回归检验,分析术后腭咽闭合功能变化的规律及影响因素。结果 共纳入165例患者,其中31例患者出现前后腭咽闭合功能不一致,即初次复诊判定为腭咽闭合不全（VPI）而在二次复诊转为腭咽闭合完全（VPC）,占总数18.79%;134例患者前后复诊腭咽闭合功能一致。腭咽闭合功能前后一致的患者平均年龄显著小于不一致的患者。手术年龄越小,在初次复诊时,患者的腭咽闭合功能更容易达到稳定。患者在术后15、28、40个月时,腭咽闭合功能达到稳定的比例为80%、90%、95%。结论 腭裂术后腭咽闭合功能的恢复是一个动态过程,早期的VPI可能发展为VPC,但VPC不会再转变为VPI。复诊时间是腭咽闭合功能评估结果前后一致性最重要的相关因素,选择合适的复诊时间,有利于获得稳定准确的腭咽闭合功能评估结果。     

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。     

腭裂手术年龄对腭咽闭合运动连续性的影响

目的研究在不同年龄修复腭裂对腭咽闭合运动连续性的影响。方法将102例年龄在10岁以上、腭裂术后2年以上的单侧完全性唇腭裂患者,根据接受腭裂手术时的年龄分为三组,A组:0～3.00岁组(n=37),B组:3.01～6.00岁组(n=36),C组:6.01岁以上组(n=29)。随访时进行鼻咽纤维镜检查,对其腭咽闭合运动是否为连续性运动进行判定,并对不同手术年龄组间腭咽闭合运动连续性的差异进行统计学检验。结果三组中连续性腭咽闭合运动患者的比例分别为83.8%(A组)、66.7%(B组)和44.8%(C组),不连续性腭咽闭合运动患者的比例分别为16.2%(A组)、33.3%(B组)和55.2%(C组)。腭咽闭合运动的连续性在3组间的差异有显著性(P0.05)。结论在不同年龄进行腭裂修复术,其术后腭咽闭合运动的连续性不同。手术年龄越小,连续性越好。     

Analysis of velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of older patients with cleft palate：experience from a major craniofacial surgery centre in eastern China

We aimed to evaluate velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of cleft palate in patients over five years old. Fifty-eight patients were reviewed between the years 2013 and 2017, 31 of whom were treated with Sommerlad palatoplasty combined with sphincter pharyngoplasty, (mean age 15 (range 9 - 22) years), and 27 were treated with Sommerlad palatoplasty alone (mean age 18 (range 10-25) years). Velopharyngeal function was evaluated by radiographic lateral cephalometry and nasoendoscopy. Hypernasality, nasal emissions, and intelligibility were used to assess speech. The rate of velopharyngeal competence was 20/31 in the palatoplasty plus pharyngoplasty group and 7/27 in the palatoplasty alone group after surgical treatment (p = 0.003). The improvements in hypernasality (p = 0.024), air emission (p = 0.004), and speech intelligibility (p = 0.004) in the palatoplasty plus pharyngoplasty group was better than that in the palatoplasty alone group. It has been suggested that the surgical approach with the palatoplasty together with the sphincter pharyngoplasty has a higher rate of success in surgical repair of older patients with cleft palate.     

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.     

A treatment algorithm for secondary cleft palate repair based on age and preoperative velopharyngeal closure ratio

This study aimed to find a surgical treatment algorithm for secondary velopharyngeal insufficiency (VPI), with Furlow palatoplasty or posterior pharyngeal flap (PPF), balancing speaking and breathing. Non-syndromic cleft palate patients with secondary VPI who underwent Furlow palatoplasty or PPF were reviewed. A multinomial logistic regression model was employed to estimate the association between preoperative variables and surgical outcomes. A series of multinomial logistic regression models was utilized to determine the cut-off value of the significant predictors for subgroup comparison. In total, 203 patients were enrolled, with 73 receiving Furlow palatoplasty and 130 receiving PPF. The surgical outcomes of the two techniques were significantly different (p = 0.005). Age was a significant predictor in all intragroup comparative analyses. Preoperative VCR was associated with postoperative velopharyngeal function in patients undergoing Furlow palatoplasty (p = 0.042). The best cut-off values were an age of 13 years and a VCR of 70%. Surgical outcomes in both group B (age <13, VCR <70%; p = 0.017) and group C (age ≥13, VCR ≥70%; p = 0.003) differed significantly between the two surgical techniques. Within the limitations of the study, it is seems that in patients aging <13 years and with a VCR of ≥70%, Furlow palatoplasty should be preferred whenever appropriate to receive adequate velopharyngeal function.     

下颌体阶梯形截骨在颌骨畸形矫正的应用

本文回顾分析了１９８８年１１月～１９９４年２月间在香港大学口腔颌面外科接受下颌体阶梯形截骨手术（口内进路）的８７个病例，男性３１例，女性５６例，平均年龄２３岁。畸形分类：下颌前突畸形伴不同程度的上颌骨发育不良５３例，下颌骨前突畸形１６例，下颌骨不对称畸形８例，颅面综合征等１０例。治疗：双颌联合手术７８例，单独下颌体截骨９例。同期做的上颌骨手术中，ＬｅＦｏｒｔⅠ型７４例，ＬｅＦｏｒｔⅡ型４例。其中２０例有严重上下颌不协调的病例，同期做了ＬＥＦｏｒｔⅠ型、下颌体阶梯形截骨和升支的截骨手术。作者认为，下颌体阶梯形截骨可用于矫正不同类型的下颌骨畸形，也可与上颌截骨或／和下颌升支截骨联合应用，矫正严重颌面畸形。     

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.     

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.     

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.     

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。     

大龄腭裂患者治疗模式的初步研究

目的改进大龄腭裂患者的治疗模式,提高大龄腭裂患者术后的腭咽闭合率和语音清晰度。方法对37例年龄大于6岁（含6岁）的腭裂患者进行同期腭裂与腭咽肌瓣咽成形整复术,并对其术后10~15个月的效果进行了随访和语音评估。结果22例患者术后腭咽闭合完全,15例术后虽仍有腭咽闭合不全,但在鼻咽纤维镜下腭咽闭合度达85%以上;所有患者X线侧位咽腔造影显示软腭与咽后壁贴合;语音检测显示,高鼻音和鼻漏气程度显著下降,辅音清晰度提高。结论本研究中建立的大龄腭裂患者治疗模式可以显著提高腭裂患者术后的腭咽闭合率和语音清晰度,为改善其生存质量创造了条件。     

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.     

两种腭裂修复方式治疗过宽不完全腭裂的临床效果比较

目的:比较兰氏法和改良兰氏法修复过宽不完全腭裂的临床效果。方法:选取2012年1月~2014年12月于徐州医科大学附属徐州市立医院接受腭裂修复术的不完全腭裂患儿40例,年龄2~5岁,裂隙宽度均大于2.5 cm,按接受腭裂修复的不同方式分为2组,实验组:20例,行改良兰氏法(兰氏法联合颊肌黏膜瓣)修复腭裂,对照组:20例,行兰氏法修复腭裂。2017年1月~2019年9月(术后5~7年)进行随访,此时两组患者年龄7~9岁,平均年龄为8岁。分别观察两组患者术区恢复状态,应用锥形束CT(CBCT)观察比较上颌骨发育情况,使用头颅侧位片评价腭咽闭合功能,并且进行语音清晰度评估。结果:相比于对照组,实验组的患者恢复较好,术区瘢痕轻微,上颌骨发育好,腭咽闭合完全,语音清晰度高。结论:对于裂隙过宽的腭裂患者,使用联合颊黏膜瓣的兰氏法可有效避免裸露的骨面,减轻了瘢痕增生,有利于上颌骨发育,增进腭咽闭合,提高了语音清晰度是一种更为值得推广的腭裂新手术方法。     

同期咽后壁组织瓣转移修复后大龄腭裂患者语音改善效果的评价

目的探讨咽后壁瓣转移修复术对大龄腭裂患者语音效果的影响。方法选择2006年8月～2008年8月就诊于青岛大学医学院附属医院口腔颌面外科的大龄腭裂患者37例,20例采用两瓣法关闭裂隙并同期行咽后壁瓣转移修复术;17例单纯关闭裂隙。比较手术前后腭咽闭合不全率（RVPI）,单元音[i]三个共振峰频率,辅音[ka]、[pa]、[si]、[qi]冲直条和擦音乱纹及语音清晰度变化,并与健康儿童20例对照。结果所有患者均达到临床Ⅰ期愈合,两手术组术后RVPI均显著降低,语音也有不同程度改善,且关闭裂隙同期行咽后壁瓣转移修复术组明显优于单纯关闭裂隙组。结论大龄腭裂患者同期行腭裂修复术和咽后壁瓣转移修复术能显著改善患者的腭咽闭合功能,可作为大龄腭裂患者常规术式。     

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.     

Intravelar veloplasty: a prospective study

Preliminary results are reported from a prospective, alternated, single-institution study of the effect of intravelar veloplasty (IVV) upon postpalatoplasty velopharyngeal incompetence. Two senior surgeons standardized their operative procedures and then performed or directly supervised all surgery. Patients alternately had palatoplasty with or without IVV. One speech pathologist conducted all perceptual speech and language evaluations without knowledge of the surgical procedure when the children were 3 years of age. The IVV and non-IVV groups were similar with respect to cleft anatomy, mean age at palatoplasty, and audiograms at 1 and 3 years of age. The findings from a sample of 51 patients were that surgical retropositioning and approximation of the levator muscles during initial palatoplasty (1) did not demonstrably affect the incidence of postpalatoplasty auditory perceptual symptoms of velopharyngeal incompetence; (2) required a significantly longer operating time; (3) were costlier than the control procedure; and (4) did not have greater morbidity than the control procedure. These findings suggest either that there is no beneficial effect of IVV upon postpalatoplasty velopharyngeal competence or that the effect, if present, is of small magnitude.     

72例腭隐裂修复方式的回顾分析

目的：通过回顾性分析8年的腭隐裂修复治疗，寻求较合适的修复方法及修复时机。方法：1999年9月至2007年1月行腭隐裂修复的患者72例，男37例，女35例，年龄1-35岁，平均11．2岁。术后1个月复诊，检查伤口愈合情况，并进行语音评估。同时将72例患者按所接受的手术方法分为三组：Ⅰ组（腭成形术），Ⅱ组（改良咽后壁组织瓣转移术），Ⅲ组（腭咽成形术）；按手术年龄将其分为：〈4周岁；t〉4周岁、〈8周岁；≥8周岁三组，统计各组的构成比，及比较各组术后的腭咽闭合及语音情况。结果：术后穿孔的患者为3例（4．2％），69例患者术后接受了语音评估，1例（兰氏术后）仍遗留VPI。10例患者语音检测为正常（96．15％±2．11％），余58例患者腭咽闭合功能改善，但仍伴代偿性发音，需语音治疗。手术方式分组：Ⅰ组13例（18．1％），Ⅱ组46例（63．89％），Ⅲ组13例（18．1％）；年龄分组：〈4周岁7例（9．72％），t≥4周岁、但〈8周岁25例（34．72％），≥8周岁40例（55．56％）。〈4周岁的患者采用腭成形术最多，占57．1％，≥4周岁、但〈8周岁及≥8周岁的患者采用改良咽后壁组织瓣转移术的最多，各占68％，和70％。语音评估发现〈4周岁组的患者术后正常语音的比例最高，占71．4％，其次是t〉4周岁、但〈8周岁组，正常语音的比例为该年龄组的19．2％，VP完全，有代偿性发音的占76．9％，而大年龄组（≥8周岁），均伴有代偿性发音而需语音治疗。结论：小年龄组（〈4周岁）的腭隐裂修复术后语音效果较好，大年龄组（≥8周岁）的腭隐裂修复可首选咽成形术或腭咽成形术，术后须辅以语音训练，t≥4周岁、但〈8周岁的患者修复方式的选择可根据具体情况选用。     

腭咽闭合功能生理参数的研究

目的 为区分腭裂术后生理性和病理性腭咽闭合不全，必须提出健康人群生理性ＶＰＩ－这一客观指标。