隐匿性黏膜下腭裂之MRI辅助诊断及治疗探讨

Clinical study of diagnosis of the occult submucous cleft palate assisted by MRI and its surgical treatment

目的探讨隐匿性黏膜下腭裂(occult submucous cleft palate,OSMCP)的有效诊断及治疗方案。方法8例体格检查未发现明确腭部裂隙但存在高鼻音的患者,外院体检排除系统性疾病及综合征可能。行语音评估(以高鼻音程度为评分指标)及电子鼻咽镜检查后确定存在腭咽闭合不全(velopharyngeal incompetence,VPI)。对以上患者行头颅核磁共振成像(magnetic resonance imaging,MRI)检查腭部结构,将发现存在腭帆提肌(levator veli palatine muscle,LVP)解剖异常的患者列为OSMCP病例。对其实行手术探查并行腭帆提肌重建术加软腭逆向双"Z"形瓣移位术(Furlow术式)。术后3个月行电子鼻咽镜复查腭咽闭合情况,重新行高鼻音程度评估。结果8例患者经MRI检查后有6例显示双侧LVP肌肉组织在软腭部结构不连续。外科手术过程证实这6名患者双侧LVP失去正常连接并在腭部向前方异常附着。每位患者术后语音和腭咽闭合率均得到良好改善。结论MRI能较有效可靠地辅助OSMCP诊断。OSMCP患者手术采用腭帆提肌重建合并软腭逆向双Z形瓣移位术修复腭功能效果较明显。

Objective To study the application of medical examination and treatment of occult submucous cleft palate(OSMCP).Methods Eight individuals of hypernasality without visible cleft palate who had been performed physical examination outside the hospital ruling out the systemic disease or any syndrome,were confirmed as subjects of velopharyngeal incompetence(VPI)after they were performed the speech assessment(scored by hypernasality severity)and the electronic nasopharyngoscopy inspection.Subjects who showed abnormal anatomy of levator veli palatine muscle(LVP)in the velum on the magnetic resonance imaging(MRI)were diagnosed as OSMCP.Operations were performed on OSMCP subjects to explore structures of LVP with reconstructions of LVP muscles and Furlow technique.Operated subjects received hypernasality assessment and inspection of velopharyngeal closure using electronic nasopharyngoscopy again three months after surgery.Results Six of eight VPI subjects showed disconnecting of LVP structures in the velum by the MRI examination.The surgery course verified that all six operated subjects lost continuity of the LVP in the soft palate and had levator muscles abnormal attachment forward.The six subjects’hypernasality and their rates of VPI recovered obviously after the operations.Conclusion MRI can help diagnosis of OSMCP in an effective way.The operation of reconstruction of LVP muscles plus the Furlow technique has a potentiality to improve the velar function of OSMCP patients.