| Objective:Velopharyngeal incompetence(VPI)is a common complication after cleft palate repair surgery.The problem may be due to the incomplete lengthening of the palate,lack of levator sling reconstruction,the scar contracture of the straight line closure that may even shorten the palate.All along,for patients with cleft palate,in particular,the treatment of velopharyngeal incompetence in older cleft palate patients with large fractures,what kind of operation method can improve the effect of postoperative palatine pharyngeal closure function,and did not form a unified opinion.With the continuous progress and development of stomatology and surgical technology,the method of joint surgery in the same period has gradually been more fully studied and affirmed.Double-opposing Z-palatoplasty and pharyngeal flap are two surgical techniques that have confirmed the mature effects of today's technology.The advantage DOZ lies in the anatomical reconstruction of the palate muscles and the extension of the soft palate,and the "Z"-shaped suture reduces the contracture of the scar and has less effect on maxillary development,has been widely used clinically and proved to be an effective method for the treatment of velopharyngeal Incompetence.Pharyngeal flap can play a good role in blocking,in a case of when the patient is slightly older and the cleft palate is too wide can also achieve satisfactory speech effect,is considered to be the ultimate ways of treating velopharyngeal incompetence.These two kinds of operation are consistent with the choice principle of cleft palate operation method: It can not only effectively recover the voice of patients with cleft palate,but also has a minor effect on the growth of maxilla.The purpose of this study was to review the efficacy of the combination of DOZ with pharyngeal flap in the treatment of velopharyngeal incompetence by reviewing previous surgical evaluations.Method:Select 30 patients diagnosed with incomplete diagnosis of velopharyngeal incompetence in our department,no syndrome type cleft palate patients,patients who have not had repair operation of palatal pharyngeal or use Furlow reversed double-opposing Z-palatoplasty as first operation or patients with posterior wall disc pharyngoplasty,there were 16 females and 14 males,age between 5-29 years old,average age is 17.8 years old.Preoperative Nasopharyngeal Fiberoscope Mirror to check the closure rate of the palate,speech sharpness and the duration of the blown blister experiment.The Operation combined first DOZ to extend soft palate,parallel the pharyngeal flap improves the function of the velopharyngeal closure to achieve a good velopharyngeal closure.And evaluate the treatment effect after half a year,The effect of the operation was evaluated by the nasopharyngeal microscopy examination of the pharyngeal closure function,speech sharpness and blowing blister experiment.Result:The wounds of patients after surgery are clinically first-phase healing,23 patients reached velopharynegeal competence(VPC),5 cases of patients belonging to marginal palatal and pharyngeal closure,only 2 patient were VPI but the rate of velopharyngeal incompetence(RVPI)had significantly improved.The speech sharpness of all patients was improved to varying degrees.The blowing blister experiment increased from 4.3±1.1seconds before operation to 20.5±7.8 seconds.The design of Furlow palatoplasty and pharyngeal flap with modified combined application,effectively improve the rate of velopharyngeal incompetence in patients with speech sharpness and velopharyngeal insufficiency.Conclusion:Patients with VPI,simultaneous application of DOZ and pharyngeal flap in treatment,while obtaining a good function of palatal closure,the number of operation was reduced,the operation was simplified and the function of palatal closure was obviously improved.Combined use of DOZ and pharyngeal flap effectively imporves speech sharpness and velopharyngeal closure rate,is an effective method to treat velopharyngeal incompetence. |
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