咽后壁瓣断蒂对腭咽闭合影响的探讨

Division of flap in cleft palate patients after posterior pharyngeal flap surgery

目的 探讨咽后壁瓣成形术后腭咽闭合功能不全（velopharyngeal insufficiency,VPI）及其并发症阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗中咽后壁瓣断蒂的作用.方法 1993至2008年于北京大学口腔医学院·口腔医院唇腭裂治疗中心接受咽后壁瓣断蒂术患者20例（不完全腭裂11例、完全性唇腭裂9例）,20例断蒂术前均行鼻咽纤维镜、头颅定位侧位X线片检查及语音录音,对有OSAHS主述者行睡眠呼吸监测.全部患者术后48 h后进行语音评价.术中单纯断蒂14例,断蒂后重新改变咽成形术式6例.结果 ①14例成形术后语音改善不明显,仍存在过高鼻音,咽后壁瓣断蒂术后语音改善明显 ②3例成形术后虽发音正常但出现呼吸道阻塞症状,断蒂术后呼吸睡眠状况改善,语音仍正常 ③3例成形术后发音正常,因正颌手术的麻醉需要断蒂,断蒂后的语音无明显改变.结论 咽后壁瓣成形术后出现OSAHS或仍存在VPI,需手术断蒂或其他类型咽成形术治疗 断蒂的时间应在咽后壁瓣成形术半年后.

Abstract：Objective To investigate the reasons of flap division in patients with posterior pharyngeal flap and the outcome of the flap division for treating secondary velopharyngeal insufficiency （VPI） and obstructive sleep apnea-hypopnea syndrome （OSAHS）.Methods Twenty patients who underwent flap division after posterior pharyngeal flap surgery were included in this study, including 11 uncomplete cleft palate and 9 complete cleft palate）.Nasal endoscopy and lateral cephalometric radiographs were performed for all the patients preoperatively. Speech recordings were made pre- and postoperatively.The respiratory status of patients who hadOSAHS manifestations was monitored by polysomnography. Simple division of the flap was carried out in 14 cases, and additional pharyngoplasty combined the division of posterior pharyngeal flap was performed in six cases. ResultsThe speech did not show significant improvement in 14 cases after posterior pharyngeal flap surgery but improved after flap division. Three cases got speech improvement, but developed the respiratory obstruction causing sleep apnea. After the division of flap, the respiratory status got improved. Three cases required orthognathic surgery under general anesthesia, which demanded the division of flap simultaneously. The speech did not change after the division. ConclusionsIf OSAHS occurred or VPI remained after posterior pharyngeal flap surgery, the division of the flap or additional pharyngoplasty should be performed. It is suggested that the operation of the flap division be done six months after posterior pharyngeal flap surgery.