目的:本研究的目的是评估是否需要在腭修复的概念中进行二次腭矫正手术,该概念使用主腭前后闭合的方案,硬腭和软腭。
方法:评估了2001年至2021年在哥廷根大学颅面和裂口护理中心进行手术的患者的数据库。使用TennisonRandall和Veau-Cronin手术结合牙槽裂修复术修复了唇裂。CLP患者的left裂修复分两步完成,首先在10-12个月大的年龄使用vomer皮瓣修复原发性和硬腭,然后在3个月后使用Veau/两皮瓣手术进行软腭闭合。使用Veau/两瓣手术在一期手术中进行了孤立的left裂修复。年龄数据,性别,裂隙的类型,手术的日期和类型,口鼻瘘的发生和位置,我们提取了为矫正口鼻瘘(ONF)和/或咽喉功能不全(VPI)而进行的二次手术的日期和类型.骨骼矫正手术的比率被记录为手术引起的面部生长障碍的代表。
结果:在评估的195例非综合征完全CLP患者中,共进行了446例牙槽裂修复和腭裂修复手术(VeauI至IV).1例患者(0.5%),发生了需要进行二次维修的ONF。此外,1例患者(0.5%)需要进行二次手术以矫正VPI,导致二次腭手术的总发生率为1%.在15-22岁的年龄组(n=31)中,有6例(19,3%)患有完全CLP的患者进行了骨骼矫正手术。
结论:所提供的数据表明,对于ONF和VPI的二次矫正手术,在相对较低的骨骼矫正需求下,对原发性腭和硬腭进行两步序贯封堵,然后再进行软腭封堵,与最低比率相关。
OBJECTIVE: The aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate.
METHODS: A data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10-12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance.
RESULTS: In the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 - 22 years (n = 31).
CONCLUSIONS: The presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.