A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting
A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting
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DOI：
10.1097/prs.0b013e31817d6223
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发表时间：
2008-08-01
影响因子：
3.6
通讯作者：
Serletti, Joseph M.
中科院分区：
文献类型：
--
作者：
Losee, Joseph E.;Smith, Darren M.;Serletti, Joseph M.
背景资料：腭部手术包括（1）一期腭部成形术，（2）口鼻瘘修复术，（3）二期腭部成形术治疗咽功能不全。任何时候进行腭部手术，术后瘘管仍然是潜在的后果。这里提出的是一个成功的算法，用于执行腭手术，并减少术后瘘率在一个大的，单外科医生，连续series.Methods：回顾性分析所有连续腭手术之间进行2002年和2006年，包括（1）原发性腭成形术，（2）口鼻瘘修复，（3）二次腭成形术的腭咽功能不全进行。本文综述了Veau裂的类型、手术技术和结局。该算法包括（1）放松切口，（2）完整的intravelar veloplasty，（3）张肌腱的总释放，（4）解剖神经血管束与选择性截骨的孔，和（5）结合脱细胞真皮基质，以实现完整的鼻衬里reconstruct.Results：二百六十八腭程序进行：（1）132例初次Furlow腭成形术，1例出现症状性Furlow腭成形术后瘘（0.76%）（脱细胞真皮基质用于39.4%的初次腭裂修复术）;（2）55例口鼻瘘修补术，产生2例有症状的术后瘘（3.6%）（90.9%的瘘修补术使用脱细胞真皮基质）;（3）81例因咽功能不全而进行的二期腭裂修复术，术后无瘘发生。脱细胞真皮基质用于腭咽闭合不全的二期腭裂修复占14.8%。没有建议语音手术后palatoplasty.Conclusions：在这单外科医生连续系列的268例中，作者实现了最低的术后瘘的发病率报告在所有形式的腭程序，包括最低的发病率（0.76%）的症状性腭瘘以下的主要Furlow腭成形术。
Background: Palatal procedures include (1) primary palatoplasty, (2) oronasal fistulas repair, and (3) secondary palatoplasty for velopharyngeal insufficiency. Any time a palatal procedure is performed, postoperative fistulas remain potential consequences. Presented here is a successful algorithm for performing palatal procedures and decreasing the rate of postoperative fistulas in a large, single-surgeon, consecutive series.Methods: A retrospective review of all consecutive palatal procedures performed between 2002 and 2006 including (1) primary palatoplasty, (2) oronasal fistulas repair, and (3) secondary palatoplasty for velopharyngeal insufficiency was performed. Cleft Veau type, surgical technique, and outcomes are reviewed. The algorithm included (1) relaxing incisions, (2) complete intravelar veloplasty, (3) total release of the tensor tendon, (4) dissection of the neurovascular bundle with optional osteotomy of the foramen, and (5) incorporation of acellular dermal matrix to achieve complete nasal lining reconstruction.Results: Two hundred sixty-eight palatal procedures were performed: (1) 132 primary Furlow palatoplasties yielding one symptomatic post-Furlow palatoplasty fistula (0.76 percent) (acellular dermal matrix was used in 39.4 percent of primary palatoplasties); (2) 55 oronasal fistula repairs yielding two symptomatic postoperative fistulas (3.6 percent) (acellular dermal matrix was used in 90.9 percent of fistula repairs); and (3) 81 secondary palatoplasties for velopharyngeal insufficiency resulting in no postoperative fistulas. Acellular dermal matrix was used in 14.8 percent of secondary palatoplasties for velopharyngeal insufficiency. No recommendations for speech surgery followed palatoplasty.Conclusions: Using the proposed algorithm in this single-surgeon consecutive series of 268 cases, the authors achieved the lowest reported incidence of postoperative fistulas in all forms of palatal procedures, including the lowest incidence (0.76 percent) of symptomatic palatal fistulas following primary Furlow palatoplasty.