Clinical effect of the modified pharyngeal flap of bilateral muscular rings in the treatment of moderate and severe velopharyngeal insufficiency
10.3760/cma.j.cn112144-20231031-00230
- VernacularTitle:改良双肌肉环咽后壁瓣术矫治中重度腭咽闭合不全的临床效果研究
- Author:
Simo WU
1
;
Bing SHI
;
Zhihe ZHAO
;
Junrui ZHANG
;
Haiqiang LI
Author Information
1. 第四军医大学口腔医院颅颌面整形与美容外科 口颌系统重建与再生全国重点实验室 国家口腔疾病临床医学研究中心 陕西省口腔疾病临床医学研究中心，西安 710032
- Keywords:
Velopharyngeal insufficiency;
Pharyngeal flap;
Cleft palate;
Velopharyngeal function
- From:
Chinese Journal of Stomatology
2024;59(6):617-621
- CountryChina
- Language:Chinese
-
Abstract:
To introduce the modified pharyngeal flap of bilateral muscular rings (BMR), and to discuss the clinical effect of this operation in the correction of moderate and severe velopharyngeal insufficiency. The clinical data of 18 patients who underwent BMR surgery in the Department of Craniofacial Plastic and Aesthetic Surgery, School of Stomatology, The Fourth Military Medical University from May 2019 to July 2021 were retrospectively analyzed. There were 10 males and 8 females, with a median age of 8.5 years (aged from 5 to 34 years). The patients were diagnosed preoperatively with moderate to severe velopharyngeal insufficiency (velopharyngeal closure ratio<0.7). The results of nasopharyngoscopy and speech assessment were compared and analyzed before operation and at the follow-up 6 months after the operation to evaluate the changes in velopharyngeal function and speech. Eighteen patients underwent BMR, 4 patients had snoring (the symptom disappeared after a few weeks in 3 cases), and 2 patients had local erosion of the wound, which delayed healing. Postoperative nasopharyngoscopy showed that all patients achieved comparatively complete velopharyngeal closure, some patients got enhanced lateral pharyngeal wall motility, and all patients got active motility of posterior pharyngeal wall flap. The postoperative speech assessment was significantly improved compared with that before the operation. The preoperative median score was 9 (range 7-12), and the postoperative median score was 2 (range 0-4). The statistical analysis was performed by paired non-parametric Wilcoxon signed rank test, and the difference was statistically significant ( P<0.001). BMR is a reliable method for the treatment of moderate and severe velopharyngeal insufficiency. This technique can achieve functional contraction of the full circumference of the ventilator while preserving the obstructive effect of the posterior pharyngeal wall flap, which is helpful to balance nasal ventilation and velopharyngeal closure and improve the velopharyngeal function of patients.
