Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery.

IF 2.4 2区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Head & Face Medicine Pub Date : 2024-03-09 DOI:10.1186/s13005-024-00418-0
Philipp Kauffmann, Johanna Kolle, Anja Quast, Susanne Wolfer, Boris Schminke, Philipp Meyer-Marcotty, Henning Schliephake
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Abstract

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.

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对非综合症 CLP 患者进行两阶段腭修复,采用前向后闭合,只需进行极少量的二次腭手术。
研究目的本研究的目的是评估腭裂修复概念中的二次腭矫正手术的必要性,该概念采用了从前方到后方关闭原发腭、硬腭和软腭的方案:方法:对 2001 年至 2021 年期间在戈廷根大学颅颌面和唇裂治疗中心接受手术的患者进行了评估。唇裂修复采用 Tennison Randall 和 Veau-Cronin 手术,同时进行齿槽裂修复。CLP患者的腭裂修复分两步进行,首先在10-12个月大时使用穹隆瓣修复原发腭和硬腭,然后在3个月后使用Veau/双瓣手术进行软腭闭合。孤立性腭裂修复手术采用Veau/双瓣手术,分一个阶段进行。研究人员提取了患者的年龄、性别、腭裂类型、手术日期和类型、口鼻瘘的发生和位置、为矫正口鼻瘘和/或会厌咽发育不全(VPI)而进行二次手术的日期和类型等数据。骨骼矫正手术率被登记为手术引起的面部发育障碍的代表:在接受评估的 195 名非综合征完全性 CLP 患者中,共进行了 446 次牙槽骨和腭裂修复手术(Veau I 至 IV)。其中有 1 名患者(0.5%)出现腭裂,需要进行二次修复。此外,1 名患者(0.5%)需要二次手术矫正 VPI,因此腭裂二次手术的总比例为 1%。6例(19.3%)15-22岁年龄组的完全CLP患者(n = 31)需要进行骨骼矫正手术:本文提供的数据显示,先进行原发腭和硬腭的两步顺序腭裂闭合,然后再进行软腭闭合,可将ONF和VPI的二次矫正手术率降到最低,而且骨骼矫正手术的需求相对较低。
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来源期刊
Head & Face Medicine
Head & Face Medicine DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
4.70
自引率
3.30%
发文量
32
审稿时长
>12 weeks
期刊介绍: Head & Face Medicine is a multidisciplinary open access journal that publishes basic and clinical research concerning all aspects of cranial, facial and oral conditions. The journal covers all aspects of cranial, facial and oral diseases and their management. It has been designed as a multidisciplinary journal for clinicians and researchers involved in the diagnostic and therapeutic aspects of diseases which affect the human head and face. The journal is wide-ranging, covering the development, aetiology, epidemiology and therapy of head and face diseases to the basic science that underlies these diseases. Management of head and face diseases includes all aspects of surgical and non-surgical treatments including psychopharmacological therapies.
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