言語成績を向上させるための口蓋形成術の工夫

• Published in: 日本口腔外科学会雑誌 Vol. 67; no. 12; pp. 696 - 702
• Main Authors: 山西, 整, 西尾, 順太郎
• Format: Journal Article
• Language: Japanese
• Published: 公益社団法人 日本口腔外科学会 20.12.2021
• Subjects: 口蓋形成術; 早期二期的口蓋形成術; 鋤骨粘膜骨膜弁; 頰粘膜弁
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.67.696

We have been applying an early two-stage palatoplasty as our standard treatment protocol for patients with cleft lip and palate. This protocol was advocated by Nishio et al. and consists of hard palate closure at 1.5 years of age following soft palate plasty with Furlow double opposing Z-plasty conducted at 1 year of age. The aim of the protocol is to obtain good palatal development without retreating the favorable postoperative speech outcome that had been obtained by the conventional one-stage pushback palatoplasty we had previously implemented. In the present article, we firstly report speech outcomes following the early two-stage protocol, and compare the results with those obtained after pushback palatoplasty. Then, we describe surgical approaches that we incorporate recent years to obtain better speech results.　We retrospectively investigated speech outcomes of 267 children with non-syndromic unilateral cleft lip and palate (UCLP) who were born between 1990 and 2005 and received consecutive treatments in our department. Of the subjects, 152 underwent the early two-stage palatoplasty (ETS group), and 115 underwent one-stage pushback palatoplasty (PB group). Assessments concerning velopharyngeal function and articulation errors were made by an experienced speech therapist in our department. Results were stratified by the same speech therapist based on the cleft palate language test (for clinical language) published by Japanese association of communication disorders. Regarding velopharyngeal function at 4 years of age, 85.5% (130/152 cases) of the ETS group was assessed normal, 9.2% (14/152 cases) was mild velopharyngeal insufficiency (mild VPI), 5.3% (8/152 cases) was moderate VPI. No cases of VPI were found. In the PB group, 90.4% (104/115 cases) was found normal, 5.2% (6/115 cases) was mild VPI, 3.5% (4/115 cases) was moderate VPI, and 0.9% (1/115 cases) was VPI. No statistically significant difference was observed. The incidences of articulation errors at 4 years of age in the ETS group and in the PB group were 25.0% (38 cases), and 33.9% (39 cases), respectively, indicating no significant difference.　Based on the results, we are currently introducing multiple procedures in primary palatoplasty for even better speech outcome. Attention is paid to three major points; 1. radical dissection of the cleft muscle from the aponeurosis of the tensor veli palatini muscle, 2. control of velopharyngeal space by using the donor site of the vomer flap, and 3. usage of buccal myomucosal flap for cases with wide cleft.