Rotem Kimia, Cynthia B Solot, Susan M McCormack, Marilyn Cohen, Jessica D Blum, Dillan F Villavisanis, Nisha Vora, Zachary Valenzuela, Jesse A Taylor, David W Low, Oksana A Jackson
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引用次数: 0
Abstract
Objective: Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients.
Setting: An academic tertiary pediatric care center.
Methods: Retrospective cohort study.
Patients: Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL).
Outcome measures: The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS).
Results: 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P < .001) and were more likely to have severe VPD per PWSS (OR 4.28, P < .01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant (P < .001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P < .05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P < .05).
Conclusion: Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP.
目的:约有 30% 的腭裂(CP)修复患者会出现咽喉功能障碍(VPD)。本研究探讨了腭裂患者中VPD的手术治疗方法和术后语言效果:地点:一家学术性三级儿科护理中心。方法:回顾性队列研究:方法:回顾性队列研究:患者:2010年1月1日至2020年12月31日期间接受过VPD手术治疗的CP修复史患者(Veau I-IV)。手术方式包括咽后皮瓣(PPF)、括约肌咽成形术(SPP)、Furlow腭再修复术和颊黏膜瓣腭延长术(PL):结果:97 名患者符合纳入标准:97名患者符合纳入标准。结果:97 名患者符合纳入标准,38 名曾接受过直线原发性腭成形术的患者接受了 Furlow 再修复术;这些患者明显更年轻(7.62 岁 vs 11.14 岁,P P P P P 结论:Furlow 再修复术减少了对腭成形术的需求:Furlow再修复术减少了对额外VPD手术的需求。非再修复手术的言语效果相当,但 SPP 的并发症有所增加。
期刊介绍:
The Cleft Palate-Craniofacial Journal (CPCJ) is the premiere peer-reviewed, interdisciplinary, international journal dedicated to current research on etiology, prevention, diagnosis, and treatment in all areas pertaining to craniofacial anomalies. CPCJ reports on basic science and clinical research aimed at better elucidating the pathogenesis, pathology, and optimal methods of treatment of cleft and craniofacial anomalies. The journal strives to foster communication and cooperation among professionals from all specialties.