Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析

doi:10.7518/hxkq.2023.2023155

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (6): 713-718.doi: 10.7518/hxkq.2023.2023155

Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析

董哲(), 谢莹, 杨解纲, 傅豫川, 李健()

口腔基础医学省部共建国家重点实验室培育基地和口腔生物医学教育部重点实验室武汉大学口腔医学院口腔颌面外科，武汉 430079

收稿日期:2023-05-23 修回日期:2023-09-07 出版日期:2023-12-01 发布日期:2023-11-27
通讯作者: 李健 E-mail:dongzhe_6520@whu.edu.cn;lijian_hubei@whu.edu.cn
作者简介:董哲，医师，学士，E-mail：dongzhe_6520@whu.edu.cn

Clinical efficacy of Hogan posterior pharyngeal flap in repairing velopharyngeal insufficiency secondary to cleft palate in older patients

Dong Zhe(), Xie Ying, Yang Jiegang, Fu Yuchuan, Li Jian.()

The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China

Received:2023-05-23 Revised:2023-09-07 Online:2023-12-01 Published:2023-11-27
Contact: Li Jian. E-mail:dongzhe_6520@whu.edu.cn;lijian_hubei@whu.edu.cn

摘要/Abstract

摘要：

目的探讨使用Hogan法咽后壁组织瓣转移术治疗大龄腭咽闭合不全（VPI）患者的临床疗效。方法收集33例腭裂术后VPI患者，年龄10~35岁，平均年龄20.4岁。所有患者均行Hogan法咽后壁组织瓣转移术治疗腭咽闭合不全。采用汉语语音清晰度测定法评估患者语音情况，鼻咽纤维镜（NPF）评估腭咽闭合程度，并进行分级。平均随访时间13.3个月。结果 33例患者术后创口均达到Ⅰ期愈合。术后语音清晰度明显提高，鼻漏气及高鼻音减少，与术前相比差异有统计学意义（P<0.05）。NPF检查示，术后腭咽闭合功能明显改善，30例（91%）患者腭咽闭合率达到Ⅰ级，3例（9%）患者达到Ⅱ级。结论 Hogan法咽后壁组织瓣转移术可显著改善大龄VPI患者的腭咽闭合状况，减少鼻漏气和高鼻音。

关键词: 腭咽闭合不全, Hogan法咽后壁组织瓣转移术, 语音清晰度, 大龄患者, 鼻咽纤维镜

Abstract:

Objective The clinical effects and surgical procedures of Hogan posterior pharyngeal flap in the treatment of the older patients with velopharyngeal insufficiency (VPI) after cleft palate repair were investigated. Methods A total of 33 patients (aged 10-35 years; average of 20.4 years) with VPI secondary to cleft palate were included. They underwent Hogan posterior pharyngeal flap to improve velopharyngeal closure function. The clinical efficacy of the ope-ration was evaluated with Chinese speech clarity measurement and nasopharyngeal fiberscope (NPF), and the velopharyngeal closure was graded. The average follow-up time was 13.3 months. Results The wounds of all patients were healed by first intention, and speech assessment showed that the consonant articulation increased and the rate of hypernasality and nasal emission decreased significantly (P<0.05). NPF examination showed that the postoperative velopharyngeal closure function significantly improved, 30 cases (91%) were gradeⅠ, and 3 cases (9%) were grade Ⅱ. Conclusion Hogan posterior pharyngeal flap for VPI secondary to cleft palate can significantly improve velopharyngeal closure.

Key words: velopharyngeal insufficiency, Hogan posterior pharyngeal flap, speech intelligibility, older patient, nasopharyngeal fiberscope

中图分类号:

R 782.2⁺2

董哲, 谢莹, 杨解纲, 傅豫川, 李健. Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析[J]. 华西口腔医学杂志, 2023, 41(6): 713-718.

Dong Zhe, Xie Ying, Yang Jiegang, Fu Yuchuan, Li Jian.. Clinical efficacy of Hogan posterior pharyngeal flap in repairing velopharyngeal insufficiency secondary to cleft palate in older patients[J]. West China Journal of Stomatology, 2023, 41(6): 713-718.

图/表 6

表 1

图 1

图 2

图 3

表 2

表 3

参考文献 27

1	Losee J, Kirschner R. Comprehensive cleft care: volume two[M]. New York: Thieme Medical Publishers, 2015.
2	Meek MF, Coert JH, Hofer SO, et al. Short-term and long-term results of speech improvement after surgery for velopharyngeal insufficiency with pharyngeal flaps in patients younger and older than 6 years old: 10-year experience[J]. Ann Plast Surg, 2003, 50(1): 13-17.
3	Perry JL, Kotlarek KJ, Sutton BP, et al. Variations in velopharyngeal structure in adults with repaired cleft palate[J]. Cleft Palate Craniofac J, 2018, 55(10): 1409-1418.
4	Mason KN, Perry JL, Riski JE, et al. Age-related chan-ges between the level of velopharyngeal closure and the cervical spine[J]. J Craniofac Surg, 2016, 27(2): 498-503.
5	尹恒, 赵树蕃, 郑广宁, 等. 大龄腭裂患者治疗模式的初步研究[J]. 华西口腔医学杂志, 2010, 28(3): 294-297, 302.
	Yin H, Zhao SF, Zheng GN, et al. Investigation of the optimized surgical procedure for the cleft palate patients over six years old[J]. West China J Stomatol, 2010, 28(3): 294-297, 302.
6	Nabi S, Tan S, Husein M, et al. Superiorly based pharyngeal flap for velopharyngeal insufficiency: intermediate and longer-term perceptual speech and nasometric outcomes[J]. J Otolaryngol Head Neck Surg, 2011, 40(2): 157-166.
7	Boutros S, Cutting C. The lateral port control pharyn-geal flap: a thirty-year evolution and followup[J]. Plast Surg Int, 2013, 2013: 237308.
8	Luo X, Guo C, Yin H, et al. Comparison of Hogan pharyngeal flap and sphincter pharyngoplasty in postoperative velopharyngeal function[J]. Br J Oral Maxillofac Surg, 2020, 58(3): 291-295.
9	Calis M, Ustun GG, Ozturk M, et al. Comparison of the speech results after correction of submucous cleft palate with Furlow palatoplasty and pharyngeal flap combined with intravelar veloplasty[J]. J Craniofac Surg, 2018, 29(1): e100-e103.
10	Golding-Kushner KJ, Argamaso RV, Cotton RT, et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group[J]. Cleft Palate J, 1990, 27(4): 337-348.
11	Glade RS, Deal R. Diagnosis and management of ve-lopharyngeal dysfunction[J]. Oral Maxillofac Surg Clin North Am, 2016, 28(2): 181-188.
12	Haenssler AE, Fang X, Perry JL. Effective velopharyngeal ratio: a more clinically relevant measure of velopharyngeal function[J]. J Speech Lang Hear Res, 2020, 63(11): 3586-3593.
13	Chen PK, Wu JT, Chen YR, et al. Correction of secon-dary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty[J]. Plast Reconstr Surg, 1994, 94(7): 933-943.
14	王国民. 腭咽闭合功能不全的诊断与治疗[J]. 口腔颌面外科杂志, 2003, 13(4): 339-345.
	Wang GM. Diagnosis and treatment of velopharyngeal insufficiency[J]. Chin J Oral Maxillofac Surg, 2003, 13(4): 339-345.
15	鲁勇, 石冰, 宋庆高, 等. 腭裂术后腭咽闭合不全患者成年期腭咽结构特征的分析[J]. 实用口腔医学杂志, 2005, 21(4): 495-498.
	Lu Y, Shi B, Song QG, et al. Velopharyngeal morphology in adults with velopharyngeal incompetence after operation of cleft palate[J]. J Pract Stomatol, 2005, 21(4): 495-498.
16	Leclerc JE, Godbout A, Arteau-Gauthier I, et al. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients[J]. Laryngoscope, 2014, 124(2): 561-569.
17	Gart MS, Gosain AK. Surgical management of velopharyngeal insufficiency[J]. Clin Plast Surg, 2014, 41(2): 253-270.
18	Gosain AK, Arneja JS. Management of the black hole in velopharyngeal incompetence: combined use of a Furlow palatoplasty and sphincter pharyngoplasty[J]. Plast Reconstr Surg, 2007, 119(5): 1538-1545.
19	Wong LS, Lim E, Lu TC, et al. Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review [J]. Int J Oral Maxillofac Surg, 2019, 48(6): 703-707.
20	Liao YF, Chuang ML, Chen PK, et al. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate[J]. Cleft Palate Craniofac J, 2002, 39(3): 312-316.
21	Hogan VM. A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (l.p.c.) pharyngeal flap[J]. Cleft Palate J, 1973, 10: 331-345.
22	Rudnick EF, Sie KC. Velopharyngeal insufficiency: current concepts in diagnosis and management[J]. Curr O-pin Otolaryngol Head Neck Surg, 2008, 16(6): 530-535.
23	Instrum R, Dzioba A, Dworschak-Stokan A, et al. Surgical interventions in velopharyngeal dysfunction: compa-rative perceptual speech and nasometric outcomes for th-ree techniques[J]. J Otolaryngol Head Neck Surg, 2022, 51(1): 3.
24	Ysunza PA, Chaiyasate K, Rontal M, et al. Comparison of three different surgical techniques for designing pharyngeal flaps according to findings of videonasopharyngoscopy and multiplanar videofluoroscopy[J]. Int J Pediatr Otorhinolaryngol, 2019, 120: 123-129.
25	管新明, 谢洪. 上蒂高位咽后壁瓣移植术及其临床效果评价[J]. 实用美容整形外科杂志, 1997, 8(6): 306-308.
	Guan XM, Xie H. Upper pedicle pharyngial flap operation and the evaluation of the clinical result[J]. J Pract Aesthetic Plast Surg, 1997, 8(6): 306-308.
26	赵欣然, 蔡鸣. 不同咽成形术式对腭裂术后继发腭咽闭合功能不全合并睡眠呼吸障碍的影响[J]. 中国口腔颌面外科杂志, 2021, 19(1): 76-81.
	Zhao XR, Cai M. A retrospective analysis of sleep brea-thing disordered after pharyngoplasty for velopharyngeal insufficiency secondary to cleft palate[J]. China J Oral Maxillofac Surg, 2021, 19(1): 76-81.
27	Owsley JQ Jr, Creech BJ, Dedo HH. Poor speech following the pharyngeal flap operation; etiology and treatment[J]. Cleft Palate J, 1972, 9: 312-318.

项目		病例构成
性别	男	13
	女	20
腭裂手术年龄/岁		7.3±7.2
VPI手术年龄/岁		20.4±7.9
诊断	单侧唇腭裂	9
	双侧唇腭裂	5
	单纯腭裂	19
腭咽间隙/mm		9.3±3.9

[1]	赵宁, 刘振国, 许尧祥, 岳金, 薛令法, 肖文林. 咽后壁瓣修复术后并发阻塞性睡眠呼吸暂停的临床研究[J]. 华西口腔医学杂志, 2021, 39(5): 566-569.
[2]	王希, 郭春丽, 石冰, 尹恒. 先天性腭咽闭合不全的腭咽闭合状态及语音特点分析[J]. 华西口腔医学杂志, 2020, 38(6): 662-666.
[3]	刘楚娴,李精韬,郑谦,郭春丽,尹恒. 大龄腭裂患者术后腭咽闭合功能的影响因素分析[J]. 华西口腔医学杂志, 2019, 37(6): 626-630.
[4]	邱叶郑谦石冰李杨王 尹恒. 大年龄腭裂患者术后腭咽闭合功能的影响因素[J]. 华西口腔医学杂志, 2014, 32(1): 54-57.
[5]	刘超钦传奇王? 李伟郑谦石冰. 腭咽成形术后通气情况的随访研究[J]. 华西口腔医学杂志, 2013, 31(5): 476-478.
[6]	尹恒郭春丽石冰赵树蕃. 大龄腭裂患者术前辅音构音特点的初步研究[J]. 华西口腔医学杂志, 2013, 31(2): 182-185.
[7]	尹恒马利石冰郭春丽赵树蕃李杨. 主观判听在腭咽闭合功能诊断中的应用价值[J]. 华西口腔医学杂志, 2012, 30(2): 197-200.
[8]	李蓓石冰尹恒李杨. 语音训练对改善轻度腭咽闭合不全患者发音的研究[J]. 华西口腔医学杂志, 2010, 28(06): 623-625.
[9]	王国民,费斐,蒋莉萍,陈阳,吴忆来,李青云. 异常语音的临床分类和治疗[J]. 华西口腔医学杂志, 2002, 20(02): 112-114.
[10]	谢永建,段玉贵. 上颌前牵引对唇腭裂术后反患者腭咽闭合功能的影响[J]. , 1998, 16(04): 0-.
[11]	李锦峰,刘建华. 提取元音第三共振峰测试腭咽闭合功能的研究[J]. , 1997, 15(04): 0-.
[12]	夏田. 应用腭咽阻塞器治疗腭裂术后腭咽闭合不全[J]. , 1994, 12(04): 0-.
[13]	文抑西，刘建华. 应用计算机语音分析技术对腭裂语音元音音素的初步分析[J]. , 1994, 12(03): 0-.

Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析

Clinical efficacy of Hogan posterior pharyngeal flap in repairing velopharyngeal insufficiency secondary to cleft palate in older patients

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 27

相关文章 13

编辑推荐

Metrics

本文评价

项目	术前	术后
鼻漏气
无	0	25
轻度	2	7
中度	22	1
重度	9	0
高鼻音
正常	0	23
轻度	1	9
中度	20	1
重度	12	0

级别	术前	术后
Ⅰ级	0	30
Ⅱ级	5	3
Ⅲ级	28	0