Abstract：
Tissue adjunct is non-palatal tissue used to manage tension at the defect site by providing additional coverage. This review aimed to compare outcomes of various adjuncts employed in primary palatoplasty.
A literature search was conducted of MEDLINE, EMBASE, and Cochrane Library with keywords cleft palate, palatoplasty, surgical flaps, and allografts. Data extracted included demographics, cleft severity, primary/adjunctive techniques, outcomes, and follow-up periods. Logistic regression analyses and chi-squared tests were performed to investigate associations among variables.
A total of 1332 patients (aged 3 months-5 years) with follow-up of 1 month to 21 years were included. Cleft severity included submucous cleft (1.7%), Veau I/II (33.3%), Veau III (46.3%), and Veau IV (15.1%). Most reported techniques were Furlow (52%) and intravelar veloplasty (14.3%) for soft palate, Bardach (27.2%), and V-Y Pushback (11.1%) for hard palate. Buccal myomucosal flap (BMMF) was performed in 45.4% of cases, followed by buccal fat pad flap/graft (BFP) in 40.8% and acellular dermal matrix (ADM) in 14%. Severe clefts (Veau III/IV) were repaired more frequently with BMMF compared with ADM (p = 0.003) and BFP (p = 0.01). Oronasal fistula occurred in 3.1% of patients, and velopharyngeal insufficiency (VPI) in 4%, both associated with Veau IV (fistula: p = 0.002, VPI: p = 0.0002). No significant differences were found in fistula (p = 0.79) or VPI (p = 0.14) rates between adjuncts. In severe clefts (Veau III/IV), ADM was associated with fistula formation (p = 0.03).
Adjuncts in primary palatoplasty may mitigate unfavorable outcomes associated with severe clefts. BMMF is superior, given its inherent tissue properties, whereas BFP is effective in reducing fistula formation.
A literature search was conducted of MEDLINE, EMBASE, and Cochrane Library with keywords cleft palate, palatoplasty, surgical flaps, and allografts. Data extracted included demographics, cleft severity, primary/adjunctive techniques, outcomes, and follow-up periods. Logistic regression analyses and chi-squared tests were performed to investigate associations among variables.
A total of 1332 patients (aged 3 months-5 years) with follow-up of 1 month to 21 years were included. Cleft severity included submucous cleft (1.7%), Veau I/II (33.3%), Veau III (46.3%), and Veau IV (15.1%). Most reported techniques were Furlow (52%) and intravelar veloplasty (14.3%) for soft palate, Bardach (27.2%), and V-Y Pushback (11.1%) for hard palate. Buccal myomucosal flap (BMMF) was performed in 45.4% of cases, followed by buccal fat pad flap/graft (BFP) in 40.8% and acellular dermal matrix (ADM) in 14%. Severe clefts (Veau III/IV) were repaired more frequently with BMMF compared with ADM (p = 0.003) and BFP (p = 0.01). Oronasal fistula occurred in 3.1% of patients, and velopharyngeal insufficiency (VPI) in 4%, both associated with Veau IV (fistula: p = 0.002, VPI: p = 0.0002). No significant differences were found in fistula (p = 0.79) or VPI (p = 0.14) rates between adjuncts. In severe clefts (Veau III/IV), ADM was associated with fistula formation (p = 0.03).
Adjuncts in primary palatoplasty may mitigate unfavorable outcomes associated with severe clefts. BMMF is superior, given its inherent tissue properties, whereas BFP is effective in reducing fistula formation.
摘要：
背景：组织附属物是非腭组织，用于通过提供额外的覆盖来控制缺损部位的张力。这篇综述旨在比较原发性腭成形术中使用的各种辅助手段的结果。
方法：对MEDLINE进行了文献检索，EMBASE,和Cochrane图书馆的关键词腭裂，腭成形术,外科皮瓣,和同种异体移植。提取的数据包括人口统计，裂隙严重程度,主要/辅助技术，结果，和后续期。进行Logistic回归分析和卡方检验以调查变量之间的关联。
结果：共纳入1332例患者（3个月-5岁），随访1个月至21年。裂隙严重程度包括粘膜下裂隙（1.7％），VeauI/II(33.3%),VeauIII(46.3%),和VeauIV（15.1%）。大多数报道的技术是Furlow（52％）和用于软腭的腔内静脉成形术（14.3％），巴尔达奇（27.2%），硬腭的V-Y后移(11.1%)。在45.4％的病例中进行了颊肌粘膜皮瓣（BMMF），其次是颊脂肪垫皮瓣/移植物（BFP）占40.8％，脱细胞真皮基质（ADM）占14％。与ADM（p=0.003）和BFP（p=0.01）相比，BMMF更频繁地修复了严重的裂隙（VeauIII/IV）。3.1%的患者发生口鼻瘘,和4％的咽喉功能不全（VPI），两者均与VeauIV相关（瘘管：p=0.002，VPI：p=0.0002）。附属物之间的瘘管（p=0.79）或VPI（p=0.14）率没有显着差异。严重裂痕（VeauIII/IV），ADM与瘘形成相关(p=0.03)。
结论：原发性腭成形术中的辅助治疗可以减轻与严重裂隙相关的不利结果。BMMF是优越的，鉴于其固有的组织特性，而BFP可有效减少瘘管形成。
方法：对MEDLINE进行了文献检索，EMBASE,和Cochrane图书馆的关键词腭裂，腭成形术,外科皮瓣,和同种异体移植。提取的数据包括人口统计，裂隙严重程度,主要/辅助技术，结果，和后续期。进行Logistic回归分析和卡方检验以调查变量之间的关联。
结果：共纳入1332例患者（3个月-5岁），随访1个月至21年。裂隙严重程度包括粘膜下裂隙（1.7％），VeauI/II(33.3%),VeauIII(46.3%),和VeauIV（15.1%）。大多数报道的技术是Furlow（52％）和用于软腭的腔内静脉成形术（14.3％），巴尔达奇（27.2%），硬腭的V-Y后移(11.1%)。在45.4％的病例中进行了颊肌粘膜皮瓣（BMMF），其次是颊脂肪垫皮瓣/移植物（BFP）占40.8％，脱细胞真皮基质（ADM）占14％。与ADM（p=0.003）和BFP（p=0.01）相比，BMMF更频繁地修复了严重的裂隙（VeauIII/IV）。3.1%的患者发生口鼻瘘,和4％的咽喉功能不全（VPI），两者均与VeauIV相关（瘘管：p=0.002，VPI：p=0.0002）。附属物之间的瘘管（p=0.79）或VPI（p=0.14）率没有显着差异。严重裂痕（VeauIII/IV），ADM与瘘形成相关(p=0.03)。
结论：原发性腭成形术中的辅助治疗可以减轻与严重裂隙相关的不利结果。BMMF是优越的，鉴于其固有的组织特性，而BFP可有效减少瘘管形成。
