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横形折叠咽后瓣修复腭裂及腭咽闭合不全

介绍一种改良的咽后壁瓣——横形折叠咽后瓣。修复腭裂及腭咽闭合不全患者16例。手术的主要目的在于保留咽后瓣的神经支配，消除咽后瓣自身创面和上提软腭。经6个月～12个月随访，从X线头影测量及鼻咽内窥镜检查显示术后腭咽闭合良好率为83%～100%。咽后瓣形态丰满，其软腭附着接近正常软腭提肌隆突区，对软腭运动无影响，并能明显缩小鼻咽腔，有助于达到良好的腭咽闭合。讨论了手术的优缺点。

STE的基础研究进展

LATERAL RADIOGRAPHIC COMPARISON FOR VELAR MOVEMENT BETWEEN PALATOPLASTY WITH VELOPHARYNGEAL MUSCULAR RECONSTRUCTION AND MODIFIED VON LANGENBECK’S PROCEDURE

Objective To verify the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velar movement through the lateral radiography. Methods From October 1988 to October 2000, 62 patients with cleft palate and velopharyngeal insufficiency were treated. Of them, 32 were repaired by velopharyngeal muscular reconstruction (group A) and 30 by modified von Langenbeck’s procedure (group B). The lateral radiographs and cephalometric analysis were taken. The velopharyngeal closure, velar extensibility, the angle changes of velar elevation, the distance changes of velar levator eminence based on anatomy (LEA) to velopharyngeal closure line (VCL), the varieties in LEA, the comparison of LEA and velar levator eminence based on phonation (LEP), the distance comparison between posterior nasal spine (PNS) to LEA and LEP through soft palate line (SPL) were measured. Results During the phonation, group A was significantly greater than group B in the velopharyngeal closure rate(Plt;0.01)， the velar extensibility(Plt;0.05) and the location comparison between LEA and LEP(Plt;0.01); group B was significantly greater than group A in velar elevation angle (Plt;0.05), the varieties in LEA(Plt;0.05). In velar rest position, the distance of LEA to VCL was greater inB group than in A group(Plt;0.01). There was significant difference in thedistance comparison between LEA and LEP(Plt;0.05), difference between LEA and LEP(Plt;0.01) and the distance PNS-SPL-LEA and PNSSPL-LEP(Plt;0.05) within group B; contrary to the results within group A(P＞0.05). Conclusion The velopharyngeal muscular reconstruction in palatoplasty can result in a near normalizationof anatomic measurement of velar levator muscles and improve the velar functionand velopharyngeal competence. Repositioning of velar muscles in a more anatomic correct, transverse position is more important to improve the velar length andaccordant velar movement with velopharyngeal muscles in functional palatoplasty. The velar angle change and velar elevation during phonation are not determinative factors for velopharyngeal competence.