Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis
Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis
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DOI：
10.1597/13-046
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发表时间：
2014-11-01
期刊：
影响因子：
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通讯作者：
Sommerlad, Brian
中科院分区：
文献类型：
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作者：
Gilleard, Onur;Sell, Debbie;Sommerlad, Brian
目的：黏膜下腭裂(SMCP)是一种与软腭肌发育异常相关的先天性疾病。在部分病例中，这会导致腭咽闭合不全(VPI)，治疗方法包括咽瓣手术、咽成形术和腭部重建术。方法：应用MEDLINE和EMBASE等9个数据库检索2013年1月期间发表的与SMCP手术治疗相关的文献，以确定一种或多种手术方式在改善SMCP继发VPI患者语音方面的优势。结果：26篇分析SMCP患者VPI手术结果的研究符合纳入标准。在这些研究中，语音结果是以二进制方式(即正常语音或VPI证据)或使用VPI严重程度量表来衡量的。在26项研究中，只有两项使用了盲法语音评估，12项包括了术前和术后的语音评估。结论：该综述没有发现支持任何特定手术干预的证据。这在很大程度上是由于研究人群中包含了混合的病因，以及缺乏无偏见的经验性的术前和术后语音评估。需要进一步进行严格的方法学研究，为SMCP的外科治疗提供可靠的证据基础。
Objective: Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP.Methodology: Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review.Results: Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment.Conclusions: The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.