Age and Preoperative Velar Closure Ratio Are Significantly Associated With Surgical Outcome of Furlow Double-Opposing Z-Plasty in Palatal Re-Repair
Age and Preoperative Velar Closure Ratio Are Significantly Associated With Surgical Outcome of Furlow Double-Opposing Z-Plasty in Palatal Re-Repair
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DOI：
10.1016/j.joms.2019.09.023
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发表时间：
2020-03-01
影响因子：
1.9
通讯作者：
Shi, Bing
中科院分区：
文献类型：
--
作者：
Cheng, Xu;Bo, Zhenyan;Shi, Bing
目的：腭裂修复中Furlow双对置z形成形术患者的选择标准尚不明确。本研究探讨患者的术前特征是否显著影响Furlow双对置z形成形术在腭再造术中的手术效果。材料和方法：我们设计并实施了一项嵌套在队列中的病例对照研究，该研究可分为2个阶段。第一阶段采用回顾性队列研究，收集原发性腭裂修复术后行Furlow双对置z成形术矫正腭咽功能不全患者的基本信息和术前状态。包括8个预测变量：年龄、性别、原发手术技术、腭咽闭合模式、掌膜运动、咽侧壁运动、提上肌方向和术前掌膜闭合率。结果变量为术后腭咽功能，描述为腭咽能力或腭咽功能不全。在第二阶段，进行病例对照分析，探讨影响手术结果的潜在因素。应用单因素和多因素分析来检验预测变量与手术结果之间的关系。结果：本组共83例患者，术后腭咽功能结局54例，腭咽功能不全结局29例。年龄和术前腭瓣闭合率两项预测指标均有统计学意义。14.5岁以上患者术后腭咽功能不全的可能性是14.5岁以下患者的6倍。术前膜瓣闭合比大于或等于0.9的患者术后腭咽功能不全的可能性是术前膜瓣闭合比在0.8到小于0.9之间的患者的五分之一。结论：本研究结果提示，年龄和术前膜瓣闭合率与术后腭咽功能不全有显著相关性。年龄是手术效果良好的危险因素，而术前膜瓣闭合率仍然是保护因素。(C) 2019年由爱思唯尔公司代表美国口腔颌面外科医生协会出版
Purpose: The patient selection criteria for Furlow double-opposing Z-plasty in palatal re-repair remain obscure. This study investigated whether patients' preoperative characteristics significantly affected the surgical outcome of Furlow double-opposing Z-plasty in palatal re-repair.Materials and Methods: We designed and implemented a case-control study nested in a cohort, which could be divided into 2 stages. In the first stage, a retrospective cohort study was performed to collect basic information and the preoperative status of the patients who would undergo Furlow double-opposing Zplasty to correct velopharyngeal insufficiency after primary cleft palate repair. Eight predictor variables were included: age, gender, primary surgical technique, velopharyngeal closure pattern, velar movement, lateral pharyngeal wall movement, levator muscle orientation, and preoperative velar closure ratio. The outcome variable was postoperative velopharyngeal function described as velopharyngeal competence or velopharyngeal insufficiency. In the second stage, a case-control analysis was performed to explore the potential factors affecting the surgical outcome. Univariate and multivariate analyses were applied to examine the relationship between the predictor variables and surgical outcome.Results: The sample was composed of 83 patients and resulted in 54 velopharyngeal competence outcomes and 29 velopharyngeal insufficiency outcomes after surgery Two predictors showed statistical significance: age and preoperative velar closure ratio. The possibility of postoperative velopharyngeal insufficiency in patients older than 14.5 years was 6 times higher than that in patients younger than 14.5 years. The possibility of postoperative velopharyngeal insufficiency in patients with preoperative velar closure ratios of 0.9 or greater was one fifth that in patients with preoperative velar closure ratios between 0.8 and less than 0.9.Conclusions: The results of this study suggest that age and preoperative velar closure ratio are significantly associated with postoperative velopharyngeal insufficiency Age was a risk factor in achieving good surgical outcomes, and the preoperative velar closure ratio remained a protective factor. (C) 2019 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons