Outcomes of Surgical Management of Palatal Fistulae in Patients With Repaired Cleft Palate
Outcomes of Surgical Management of Palatal Fistulae in Patients With Repaired Cleft Palate
复制标题
DOI：
10.1097/scs.0000000000005852
复制
发表时间：
2020-01-01
影响因子：
0.9
通讯作者：
Raposo-Amaral, Cassio Eduardo
中科院分区：
文献类型：
--
作者：
Denadai, Rafael;Zanco, Guilherme Luis;Raposo-Amaral, Cassio Eduardo
背景：腭瘘是腭裂修复术患者纵向随访中的一个重要的外科挑战，因为采用多种手术方法重建腭瘘的成功率各不相同，而且往往不能令人满意。这项回顾研究的目的是报告一种算法在修复腭裂患者中治疗腭瘘的临床效果。方法：连续101例有腭裂修复和腭瘘相关症状的患者根据特定的算法在2009-2017年间接受治疗。根据解剖位置(匹兹堡瘘管类型II-V型)、疤痕的数量(腭部轻微或严重疤痕)和瘘管直径(5 Mm)，3个入路中的1个(局部皮瓣[62.4%]、颊肌粘膜瓣[20.8%]或舌瓣[16.8%])进行了手术。在临床结果评估中，症状和解剖学参数(分别为瘘管报告症状和残余瘘管)被结合如下：瘘管完全闭合且无症状；无症状狭窄瘘管仍然存在；或未能修复瘘口(分别为“好”、“可”、“差”)。与手术相关的并发症数据也被收集。结果：大多数患者(91.1%)的临床结果为“良好”，范围为86.2%至100%(局部组织瓣、颊肌皮瓣和舌瓣分别为86.2%、100%和100%)。所有(8.9%)的“一般”和“较差”的结果被观察到的局部皮瓣重建的瘘管。除1期舌瓣修复术后出血(1.0%)外，未观察到与手术相关的并发症(裂开、感染或坏死)。结论：在修复的腭裂患者中，应用该算法可获得较高的瘘管解决率。
Background: The palatal fistula is an important surgical challenge within the longitudinal follow-up of patients with repaired cleft palate as the success rate of palatal fistula reconstruction by adopting several surgical techniques is variable and often unsatisfactory. The purpose of this retrospective study was to report the clinical outcomes of an algorithm for the surgical management of palatal fistulae in patients with repaired cleft palate.Methods: Consecutive patients (n = 101) with repaired cleft palate and palatal fistula-related symptoms who were treated according to a specific algorithm between 2009 and 2017 were included. Based on the anatomical location (Pittsburgh fistula types II-V), amount of scarring (minimal or severe scarred palate), and diameter of the fistula (5 mm), 1 of 3 approaches (local flaps [62.4%], buccinator myomucosal flaps [20.8%], or tongue flaps [16.8%]) was performed. For clinical outcome assessment, symptomatic and anatomical parameters (fistula-reported symptoms and residual fistula, respectively) were combined as follows: complete fistula closure with no symptoms; asymptomatic narrow fistula remained; or failure to repair the fistula ("good,'' "fair,'' or "poor'' outcomes, respectively). Surgical-related complication data were also collected.Results: Most patients (91.1%) presented "good'' clinical outcomes, ranging from 86.2% to 100% (86.2%, 100%, and 100% for local flaps, buccinator flaps, and tongue flaps, respectively). All (8.9%) "fair'' and "poor'' outcomes were observed in fistulae reconstructed by local flaps. All "poor'' (5%) outcomes were observed in borderline fistulae (4-5 mm). No surgical-related complications (dehiscence, infections, or necrosis) were observed, except for an episode of bleeding after the 1st stage of tongue flap-based reconstruction (1.0%).Conclusion: A high rate of fistula resolution was achieved using this algorithm for surgical management of palatal fistulae in patients with repaired cleft palate.