重建腭咽部肌肉对腭裂修复术后腭咽闭合状况的影响

目的 通过两组不同腭裂修复术后患者的X线造影比较观察，了解腭咽部肌肉重建对腭咽闭合状况的影响。方法 将62例腭裂及腭咽闭合不全患者分为腭咽部肌肉重建腭裂修复组(重建组)和改良兰氏腭裂修复术(非重建组)，并采用鼻咽部钡造影X线侧位片检查摄取静止和发Ⅲ音时的侧位片，对鼻咽腔面积、可移动鼻咽腔距离及腭咽闭合方式进行观察和测量，所得数据进行统计学处理。结果 重建组在腭咽闭合功能、鼻咽腔面积缩小率、静态可移动鼻咽腔中份腭咽距离和静、动态可移动鼻咽腔下份腭咽距离等方面优于非重建组，并可形成多种形式的咽后隆突-软腭闭合方式；非重建组腭咽闭合完全良好的患者在鼻咽腔面积缩小率方面要优于腭咽闭合不良的患者。结论 腭裂修复术后腭咽闭合的主要功能区在可移动鼻咽腔中份。腭裂修复术时重建腭咽肌肉有助于缩小鼻咽腔面积和提供协调的腭咽闭合活动。

A comparison of the velopharyngeal closure after palatoplasty between with or without velopharyngeal muscular reconstruction

Objective To evaluate the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velopharyngeal closure under the lateral radiography. Methods The lateral radiographs and cephalometric analysis were taken in sixty-two patients with cleft palate and velopharyngeal insufficiency, 32 repaired with velopharyngeal muscular reconstruction and 30 with modified von Langenbeck's procedure (non-reconstructive group). Results In patients with velopharyngeal muscular reconstruction, the velopharyngeal competence, the reductive rate of nasopharynx, the distance reduction in lower part of the mobile nasopharynx during phonation and the distance in middle part of mobile nasopharyngnx in rest were superior to that without velopharyngeal muscular reconstruction, and there were variform PPW eminence-soft palate contact in velopharyngeal closure. The patients with complete or good velopharyngeal closure had a definite reduction in nasopgarynx ,compared to the patients with velopharyngeal insufficiency in the non-reconstructive group. Conclusions The functional area for velopharyngeal closure after palatoplasty might be located in the middle part of mobile nasopharynx. The velopharyngeal muscular reconstruction in palatoplasty could reduce the size of nasopharynx and improve the coordination movement of velopharyngeal closure.;