Retrospective Investigation And Clinical Summary Of Surgical Managements To Velopharyngeal Insufficiency

Objective:To investigate the speech outcome for various surgical managements of velopharyngeal insufficiency,We explored the advantages and disadvantages on various techniques of velopharyngeal insufficiency repair,and summarized the introperative as well as postoperative cautions.Method:58 patients who underwent surgery for velopharyngeal insufficiency were retrospectively reviewed,in the department of oral and maxillary surgery,1st affiliated hospital,medical school of Zhejiang University from January 2005 to February 2009.The 58 patients were treated by Posterior pharyngeal flap surgery, Furlow double opposing Z-palatoplasty and Palatopharyngeous Flap surgery. Clinical data was obtained from different ways,such as the reference of clinical records,telephone follow-up and recheck information.1.The gender,age,speech outcome of Preoperation and postoperation,timing of surgery,surgical management were achieved by looking up the illness record.2.Study the degree of velopharyngeal insufficiency by physical examination and auxiliary examination,such as blowing test and Chinese speech intelligibility test.3.Carry out speech training to patients 1 month after operation,and recheck the degree of velopharyngeal insufficiency after operation.Results:4 of 58 were lost of postoperative follow-up;54 cases recovered well,free from infection;2 cases showed fistula,in which 1 case were split in the juncture of hard and soft palate,and 1 case in uvula.Recheck the degree of velopharyngeal insufficiency 3 months after operation.Then compared preoperative to postoperative value with the same surgeon by paired t-test,and the results showed that these surgical managements were significantly effective.Conclusion:1.Blowing test,Chinese speech intelligibility test and Cephalometrics are effective methods to evaluating the velopharyngeal insufficiency,because of low cost,simple work,and combination with subjective and objective assessment.2.Review to 58 patients showed that Posterior pharyngeal flap surgery,Furlow double opposing Z-palatoplasty and Palatopharyngeous Flap surgery have significant effects in speech outcome.3.The preoperative evaluation of indication,suitable surgical management, intraoperative protection for tissue and flap,and postoperative effective nursing play a crucial role in success.