The Endoscopically Assisted Pharyngeal Flap
The Endoscopically Assisted Pharyngeal Flap
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内镜辅助咽瓣
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
J. Canady
中科院分区：
文献类型：
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作者：
B. Cable;J. Canady
咽瓣手术的目的是减少咽功能不全患者的鼻咽开口，以限制异常的鼻腔气体逸出。该尺寸在需要开放鼻咽和鼻气道以实现鼻共振与需要动态闭合鼻咽括约肌以实现正常言语和吞咽之间取得平衡。侧向左舷控制技术强调了这一目标，并且自从Hogan（1973）引入以来，在文献中一直很流行。这些技术强调创建精确控制的输液港和辅助手术，试图通过最大限度地减少术后伤口挛缩和瘢痕形成来维持这些输液港。Hogan最初描述的手术方法至今仍很流行，与经典的上基咽瓣相比，有两个显著的变化。首先，创建咽瓣的宽度，以在其侧缘容纳3.5 mm直径的导管。然后这些导管引导从皮瓣到软腭的侧向闭合程度。第二，在咽瓣的创面衬上两个软腭鼻粘膜后部的皮瓣。这些衬片可以减少术后咽瓣挛缩和随后的侧口扩大（Bardach，1991）。自1990年以来，Hogan改良咽瓣一直是我们机构咽成形术的首选手术。尽管我们发现该手术非常令人满意，但仍然存在一个挑战，即术中估计最终端口尺寸和配置。这是通过经口观察的经典方法，
The aim of pharyngeal-flap procedures is to reduce the nasopharyngeal opening in patients with velopharyngeal insufficiency in order to limit abnormal nasal air escape. This dimension strikes a balance between the need for a patent nasopharynx and nasal airway to achieve nasal resonance and the need for dynamic closure of the nasopharyngeal sphincter to achieve normal speech and swallowing. Lateral port control techniques emphasize this goal and have been prevalent in the literature since their introduction by Hogan (1973). These techniques stress the creation of precisely controlled ports and adjunct procedures that attempt to maintain these ports by minimizing postoperative wound contracture and cicatrix formation. Hogan’s initially described procedure remains popular today and offers two significant changes from the classic superiorly based pharyngeal flap. First, the width of the pharyngeal flap is created to accommodate 3.5-mm diameter catheters at its lateral borders. These catheters then guide the extent of the lateral closure from the flap to the soft palate. Second, the raw surface of the pharyngeal flap is lined with two flaps taken from the posterior aspect of the soft palate’s nasal mucosa. These lining flaps minimize postoperative pharyngeal flap contracture and subsequent widening of the lateral ports (Bardach, 1991). The Hogan modification of the pharyngeal flap has been the procedure of choice for pharyngoplasty at our institution since 1990. Although we have found the procedure to be highly satisfactory, one challenge that has remained is the intraoperative estimation of the final port size and configuration. This had been classically achieved by observation transorally and