Evaluation of Two Palate Repair Techniques for the Surgical Management of Velopharyngeal Insufficiency
Evaluation of Two Palate Repair Techniques for the Surgical Management of Velopharyngeal Insufficiency
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DOI：
10.1097/prs.0000000000000506
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发表时间：
2014-10
影响因子：
3.6
通讯作者：
A. Woo;G. Skolnick;Neil S Sachanandani;L. Grames
中科院分区：
文献类型：
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作者：
A. Woo;G. Skolnick;Neil S Sachanandani;L. Grames
背景：Furlow腭成形术是腭裂患者腭咽功能不全的常用矫治方法。本文介绍了一种替代手术，包括单z形成形术和重叠的行内速度成形术（Woo腭成形术）。本研究比较了两种技术矫正腭咽功能不全的结果。方法：经机构审查委员会批准后，对所有接受二次腭成形术矫正腭咽功能不全的患者进行回顾性图表审查。对所有有影像学资料的无综合征患者进行评估。数据包括术前和术后腭咽间隙大小和知觉语音检查结果。结果：纳入52例，其中30例行Furlow腭成形术，22例行Woo腭成形术。总体而言，Woo患者（95%）比Furlow患者（63%）不需要二次手术的比例更大（p = 0.005）。然而，两组间平均手术闭合差异有统计学意义（p = 0.042）。为了更精确的评估，只有那些术前闭合80%或更高的患者被评估。Furlow的成功率为67%（15人中10人），Woo的成功率为100%（19人中19人）。同样，这个发现是显著的（p = 0.005）。线性回归分析显示腭裂类型对腭裂修复后的闭合性有显著影响（= 2.3,p = 0.013），孤立性腭裂的闭合性降低。结论：Woo腭成形术优于Furlow腭成形术。该技术似乎是一种可行的替代腭修复，特别是在情况下，当Furlow腭成形术不能进行。临床问题/证据水平：治疗性，III。
Background: The Furlow palatoplasty is commonly used for the correction of velopharyngeal insufficiency in cleft patients. An alternative procedure is introduced involving a single Z-plasty with overlapping intravelar veloplasty (Woo palatoplasty). This study compared the results of both techniques in the correction of velopharyngeal insufficiency. Methods: After institutional review board approval, a retrospective chart review was performed of all patients who had undergone secondary palatoplasty for the correction of velopharyngeal insufficiency. All nonsyndromic patients with imaging data were evaluated. Data elements included preoperative and postoperative velopharyngeal gap size and perceptual speech examination results. Results: Fifty-two subjects were included: 30 subjects had undergone Furlow palatoplasty and 22 underwent Woo palatoplasty. Overall, a larger proportion of Woo (95 percent) than Furlow subjects (63 percent) did not require secondary surgery (p = 0.005). However, mean presurgery closure was significantly different between groups (p = 0.042). For a more refined assessment, only those with 80 percent or greater preoperative closure were evaluated. Successful results were achieved in 67 percent (10 of 15) in Furlow and in 100 percent (19 of 19) in Woo. Again, this finding was significant (p = 0.005). Linear regression analysis suggested a significant effect of cleft type ( = 2.3, p = 0.013) on closure after repair, with decreased closure in cases with isolated cleft palate. Conclusions: The Woo palatoplasty compared favorably with Furlow palatoplasty for correction of velopharyngeal insufficiency. The technique appears to be a viable alternative for palatal re-repair, especially in circumstances when Furlow palatoplasty cannot be performed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.